T1DM

Question 1

what is the definition of T1DM

Answer 1

usually leads to absolute insulin deficiency, for most part caused by auto-immune process of varying severity occurring within pancreatic beta-cell

Question 2

what are the risk factors for developing T1DM

Answer 2

age, sex, race, genotype, possibly geographic location & seasonality

Question 3

describe the relation between age and T1DM

Answer 3

85% T1DM in under 20s, peak between 1014 y/o, but 25% are diagnosed as adults
(so not disease specific to young)

Question 4

describe the relation between sex and T1DM

Answer 4

M=F in young, but in Europe M>F after puberty

Question 5

describe the relation between genotype and T1DM

Answer 5

increased influence of environmental factors
HLA genes represent ~50% familial risk of T1DM
highest risk is DR3-DQ2/DR4-DQ8, confers 19 fold increased risk
(95% diagnosed under 30y/o have one of these genes)

Question 6

what are some possible environmental/accelerating factors for T1DM

Answer 6

viral infection, maternal factors, weight gain, vitamin D, puberty, stress

Question 7

what % of people in Scotland with diabetes have T1DM

Answer 7

10.7%

Question 8

what is the pathophysiology behind T1DM

Answer 8

auto-immune disease, lymphocytes attack islets of Langerhans and subsequently beta-cells causing insulin secretory defects

Question 9

what auto-antibodies are tested for in diagnoses of T1DM

Answer 9

GAD 65ab, IA-2AB, ZnT8AB

if all 3 +ve chance of T1DM >95%

Question 10

what are some of the clinical features of T1DM

Answer 10

raised glucose, ketones, decreased insulin, decreased beta-cell mass and decreased C-peptide

Question 11

what tests are sued to initially diagnose diabetes(not what type)

Answer 11

fasting glucose >/= 7mmol/L
random >/= 11mmol/L
and symptoms

Question 12

what tests are used to identify if someone has type 1 diabetes

Answer 12

often diagnosed on history and presentation(eg DKA) alone

if any doubt GAD/IA2 antibodies and C peptide may help

Question 13

what is a typical clinical presentation for someone with type 1 diabetes

Answer 13

pre-school/peri-puberty, small peak in early 30s, usually lean, acute onset, severe symptoms, severe weight loss, ketonuria +/- metabolic acidosis, no evidence of microvascular disease diagnosis, immediate and permanent requirement for insulin

Question 14

what is LADA

Answer 14

latent autoimmune diabetes of adults
late onset T1DM, probably quite common in ‘typical’ T2DM patients
ketosis = T1DM

Question 15

what HbA1c range can be sued to diagnose T1DM

Answer 15

can’t use HbA1c to diagnose T1DM

Question 16

what are some of the symptoms people with diabetes can present with

Answer 16

thirst, polyuria, thrush, weakness/fatigue, blurred vision, infections, weight loss, keto-acidosis

Question 17

when should hospitalisation be considered in diabetes presentation

Answer 17

DKA, significant ketonaemia, vomiting

Question 18

what are the aims of T1DM therapy

Answer 18

prevent hyperglycaemia, avoid hypoglycaemia and reduce chronic complications

Question 19

what is involved in the management of newly diagnosed T1DM patients

Answer 19

BG and ketone monitoring, insulin usually basal bolus regime, carb estimate, regular dietician contact, education about self-management(ie DAFNE)

Question 20

what is involved in the annual review assessment of T1DM patients

Answer 20

weight, BP, bloods(HbA1c, renal function, lipids), retinal screening, foot risk assessment

Question 21

describe the action of prandial insulin analogues, and give an example

Answer 21

onset action 10-15 mins, peak action 60-90mins, duration 4-5hrs
example = NovoRapid

Question 22

what is the benefit of an analogue basal insulin over an isophane basal insulin, and give an example of each

Answer 22

analogue = longer duration of action, less peak activity(flatter profile), can be given once or twice a day
example = Lantus(analogue), Insulatard(isophane)

Question 23

describe how most T1DM patients should be treated with insulin

Answer 23

multiple daily injections(3/4 daily) or CSII(insulin pump), educated how to match prandial insulin dose to carb intake, most should use insulin analogues(reduce hypoglycaemia risk)

Question 24

what situations decrease the likelihood of someone having T1DM, ie is it wrong diagnosis

Answer 24

diabetes diagnosed <6months old, detectable insulin production >/= 3years after diagnosis, undetectable pancreatic antibodies at diagnosis

Question 25

what are some associated auto-immune conditions with T1DM

Answer 25

thyroid disease, coeliac disease, pernicious anaemia, Addison’s disease, IgA deficiency