T1DM Flashcards
T1DM is a condition of relative/absolute insulin deficiency?
Absolute (T2DM is relative deficiency)
What’s the normal fasting glucose result? (mmol/L)
6.0mmol/L and below
What’s the normal 2-hour post OGTT glucose result?
7.7mmol/L and below
Diabetes is indicated if a random glucose tested is above what (mmol/L)
11.1mmol/L
Patients who are <1 year old are unlikely to develop T1DM. Why?
T1DM is an autoimmune condition - it usually takes years for the full beta-islet destruction to occur.
T1DM can be detected through antibody screening prior to clinical symptom onset. True/false?
True, this is “latent autoimmune T1DM”
T1DM tends to present in pre-school/school/high-school?
Pre-school and around puberty
Microvascular complications of T1DM are usually present upon diagnosis. True/false?
False
Typical presenting symptoms of T1DM (6)
1) Thirst
2) Polyuria
3) Weakness fatigue
4) Blurry vision
5) Thrush
6) UTI infections
Which tests can differentiate T1DM from T2DM?
Type 1: GAD / anti-Islet antibodies present, ketonuria, C-peptide will be low in T1DM (high in T2DM)
“Type 3 diabetes” commonly refers to that which is…
Secondary to other disease (e.g. pancreatic disease), drug induced, caused by genetic abnormalities
HbA1C provides a snapshot of insulin control over which time-frame?
Previous 2-3 months
The macrovascular complications of diabetes include (3)
1) Heart disease and stroke
2) Foot ulcer
3) Peripheral vascular disease
The microvascular complications of diabetes include (3)
1) Retinopathy
2) Neuropathy
3) Nephropathy
What’s the strongest established risk factor for development of T1DM?
Monozygotic twin has T1DM (30-50% risk)
What’s the general population risk for developing T1DM?
1:250 to 1:300
If both parents have T1DM, how likely is a child to develop it?
30%
What carries greater risk; a mother or father with T1DM?
Father
HLA genes represent what % of familial risk for T1DM?
50%
Which two HLA-types are the highest risk for development of T1DM? What’s the increased fold in risk?
DR3-DQ2
DR4-DQ8
19-fold risk
The diagnoses of T1DM has a seasonal variation. True/false?
True (more made in winter months)
Can viral infection trigger T1DM?
Yes
C-peptide loss is one of the first signs of T1DM. True/false?
False - C-peptide is the LAST factor to be lost.
Classical triad of symptoms for T1DM?/
Polyuria (may present with enuresis in children), polydipsia, weight loss
Describe the difference between basal and bolus insulins?
Basal insulin = a long acting insulin (usually given OD)
Bolus = a “with-meals” regimen
What’s the target HbA1c for T1DM?
48-58mmol/L
T1DM accounts for which % of diabetes diagnoses in those <25 years old?
90%
How many T1DM will have CF?
20%
Insulin is secreted into which structure?
Hepatic portal vein
Do T1DM tend to present with HHS or DKA?
DKA
LADA is defined as
Presence of pancreatic auto-antibodies in patients with recently diagnosed diabetes in patients who do NOT require insulin
LADA is AKA
“slowly progressive T1DM”
When should LADA be considered? (4)
1) Autoantibody positive
2) Non-insulin requiring at positive
3) Associated with other autoimmune conditions
4) Non-obese
Around what % of CF patients develop T1DM?
25%
Wolfram Syndrome encompasses (4)
1) Diabetes Insipidus
2) DM
3) Optic atrophy
4) Deafness
Bardet-Biedl Syndrome signs (3), what’s it associated with?
Signs: obese, polydactyly, visual impairment. Associated with consanguineous marriage (2nd cousins or closer)
What’s the prevalence of coeliac disease in T1DM patients?
1:20
Coeliac disease antibody test
anti-TTG positive
Thyroid disease is how common in T1DM?
1:20
Can T1DM be diagnosed on a single fasting glucose >7.0mmol/L?
No, requires symptoms OR a repeat testing
T1DM often needs antibodies to confirm?
No, often on history (e.g. DKA)
Signs of hypoglycaemia include (3)
1) Pallor
2) Tremor
3) Hunger
Basal insulin normally accounts for around what % of insulin produced?
50% (rest is post-prandial)
Target blood glucose for T1DM patients pre-meals?
3.9-7.2mmol/L
Target blood glucose for T1DM post-meal?
<10mmol/L
NovoRapid is a rapid/long acting insulin.
Rapid
Rapid insulin analogues tend to have peak action after how long?
60-90 minutes
How long do rapid-
insulin analogues typically last?
4-5 hours
ActRapid and Humulin S are examples of what insulin type?
Soluble insulin analogues
Soluble insulin tends to peak after how ong?
2-4 hours
Humulin I is a basal / bolus insulin?
Basal
Lantus (Glargine) is basal / bolus insulin?
Basal
DAFNE is used in T1DM. True/false?
True - Dose Adjustment for Normal Eating
Insulin pumps continuously inject short / long acting insulin?
Short-acting
Insulin pumps are only designed to adminster basal doses of insulin. True/false?
False - can give boluses
Metabolic control in T1DM can be measured through which laboratory investigations? (3)
1) BG monitoring
2) Urinalysis
3) HbA1c
The formation of HbA1c is enzymatic. True/false?
False - occurs naturally in response to a high glucose
What’s the injection site complication of multiple insulin injections?
Lipohypertrophy
What are the top 3 errors in prescribing insulin?
1) Wrong dose
2) Omitted medicine (i.e. someone has given a dose before & not recorded)
3) Wrong type of insulin
Should insulin be omitted if patient is hypoglycaemic?
No - treat hypoglycaemia but continue insulin (prevents reactive hyperglycaemia)
What’s the general aim of diet in management of T1DM/
Consistent quantities of CHO
Name an advanced carbohydrate counting programme.
DAFNE
Does advanced calorie counting lead to long-term benefit?
Not really (no evidence for change in weight loss or lipid profile)
What are the short-term (6 month) effects of advanced calorie counting? (3)
Better HbA1c, more freedom of diet, increased QoL
What is the standard treatment in early-stages of hypoglycaemia?
15-20g simple carbohydrate
List the most common causes of hypos (3)
1) Missed/delayed meal
2) Not enough CHO in last meal
3) Increased exercise
Patients are safe from hypos 6 hours after exercise. True/false?
False - can occur 12-24 hours after exercise. (esp if exercise is >60 minutes moderate)
Why should exercise be avoided in low insulin states?
Leads to low glucose absoprtion into muscles and muscles will secrete glucagon which can cause hyperglycaemia
True/false: sucrose has a different profile than other CHOs?
False
Sweetners are always non-nutritive (i.e. cannot be reduced to CHOs)?
False
Diabetic foods should be recommended to diabetic patients, true/false?
False
Low GI foods raise BG slowly. True/false?
True
In practice, low GI foods should be recommended. True/false?
False - no evidence to suggest benefit, more important is total CHO content
Is there evidence to suggest all DM patients should be given vitamin supplements?
No, only benefit if there is a deficiency
