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YR6: ENDO > T1DM > Flashcards

T1DM Flashcards

1
Q

What is T1DM?

A

absolute insulin deficiency due to AI destruction of the insulin-producing beta cells in the pancreas.

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2
Q

Describe onset/ presentation of T1DM

A

Often acute (hours-days)
Presents as DKA

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3
Q

List 4 risk factors for T1DM

A

HLA-DR3 + HLA-DR4
Hashimoto thyroiditis
Coeliac
Primary adrenal insufficiency

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4
Q

List 4 classic symptoms of T1DM

A

Polyuria
Polydipsia
Weight loss
Fatigue

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5
Q

What investigations are performed in suspected T1DM?

A

Urine dip: glucose + ketones
Fasting + Random glucose
+/- C-peptide
+/- Autoantibodies

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6
Q

Which antibodies are commonly found in T1DM?

A

Anti-glutamic acid decarboxylase (Anti-GAD)
Islet cell antibodies (ICA)

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7
Q

What is the criteria for diagnosis of T1DM?

A

Symptomatic +
Fasting glucose >,7.0 mmol/l
Random glucose >,11.1 mmol/l (or after 75g OGTT)

If asymptomatic the above criteria apply but must be demonstrated on 2 separate occasions.

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8
Q

When should antibodies and C-peptide be checked?

A

If T1DM suspected but clinical presentation inc. atypical features (e.g. >,50y, BMI >, 25 kg/m², slow evolution of hyperglycaemia or long prodrome)

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9
Q

When can T1DM be diagnosed on clinical grounds?

A

Hyperglycaemia + >,1 of:
ketosis
rapid weight loss
age of onset <50y
BMI <25 kg/m²
Personal / FH AI disease

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10
Q

Describe use of HbA1c in T1DM

A

Monitor every 3-6 months
Adult target: ,< 48 mmol/mol (6.5%)

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11
Q

Describe self-monitoring in T1DM

A

At least 4x/day, inc. before each meal + before bed

More frequent monitoring if:
freq of hypoglycaemic episodes increases
Illness
Before, during + after sport
When planning pregnancy, during pregnancy + while breastfeeding

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12
Q

Describe management of T1DM

A

Individual care plan set up by diabetes specialist team
Structured education e.g. DAFNE (dose-adjustment for normal eating)
Lifestyle management
Diabetes UK support site

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13
Q

What are blood glucose targets in T1DM?

A

5-7 mmol/l on waking
4-7 mmol/l before meals at other times of the day

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14
Q

3 types of insulin regimen

A

Multiple daily injection basal–bolus insulin regimens

Mixed (biphasic) regimen

Continuous insulin infusion (pump) therapy

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15
Q

Describe rapid and short acting insulins

A

Quick onset + short duration of action

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16
Q

Rapid acting insulin onset and duration of action. 2 examples

A

Onset: 15 mins
Duration: 2–5h

Humalog (insulin lispro)
+
Novorapid (insulin aspart).

17
Q

Short acting insulin onset and duration of action. 1 example

A

Onset: 30–60 mins
Duration: up to 8h

Actrapid

18
Q

Intermediate acting insulin onset, maximal effects window and duration of action. 1 example

A

Onset: 1–2h
Max. effects: 3–12h
Duration: 11–24h

Humulin I, Insuman Basal, + Insulatard.

19
Q

Long acting insulin duration of action and time to reach steady state constant level of insulin. 2 examples

A

Duration: 24h
Steady-state level achieved after 2–4 days to produce a constant level of insulin.

Lantus (insulin glargine)
Levemir (insulin detemir),

20
Q

Describe multiple daily injection basal-bolus insulin regimens. What are the benefits of this

A

Short/ rapid-acting insulin before meals
+
>,1 separate daily injections of intermediate/ long-acting insulin to cover basal requirement.

Offers greater flexibility for blood glucose control.

21
Q

Describe the mixed (biphasic) insulin regimen

A

1, 2 or 3 insulin injections per day of short/ rapid-acting insulin mixed with intermediate-acting insulin.

22
Q

Describe continuous subcutaneous insulin infusion (insulin pump) therapy

A

Programmable pump + insulin storage reservoir that gives a regular/ continuous amount of insulin (usually in the form of a rapid/ short-acting insulin) by a SC needle or cannula.

23
Q

Which insulin regimen is first line in adults with T1DM?

A

Multiple daily injection basal-bolus regimen
Long acting: Insulin detemir BD
+
Rapid acting before meals

24
Q

What should T1DM patients be provided with?

A

Insulin injection device
Needles for pen injectors
Sharps bin
Blood glucose meter, test strips + lancets
Ketone meter, test strips, lancets
Glucose/ glucagon kit for hypos

25
Q

Describe sick day rules in T1DM

A

DO NOT STOP INSULIN (risk DKA)
Check BMs more frequently, every 1–2h including through the night
Consider checking blood/ urine ketones regularly

26
Q

Describe nutrition advice for T1DM when unwell

A

If appetite reduced: Carbohydrate-containing drinks (milk, milkshakes, fruit juices + sugary drinks)

Aim 3L fluid per day to prevent dehydration

27
Q

Which site has the fastest absorption rate of insulin?

A

Abdomen

28
Q

What should patients be advised about injection sites in T1DM?

A

Check injection sites regularly
Rotate to prevent lipohypertrophy + cutaneous amyloidosis

YR6: ENDO (17 decks)

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