T1DM vs T2DM

Question 1

What is the effect of insulin balanced against?

Answer 1

• Glucagon
• Catecholamine (adrenaline and noradrenaline)
• Cortisol
• Growth hormone

Question 2

What is diabetes?

Answer 2

Reduction in insulin action sufficient to cause hyperglycaemia that, over time, will result in diabetes specific, microvascular (capillary) pathology in eyes, kidneys and nerves

Question 3

What tests do you order to diagnose DM?

Answer 3

- HbA1c
OR
- Fasting glucose
OR
- Random plasma glucose
- GAD antibody test
- Urine dipstick

Question 4

What would the diagnostic results show for DM?

Answer 4

• HbA1c ≥ 48 mmol/mol
• Fasting plasma glucose ≥ 7 mmol/L
• Random plasma glucose ≥11 mmol/L

Question 5

Why is a urine dipstick performed in diabetes diagnosis?

Answer 5

To monitor glucose and ketones

Question 6

Why are GAD antibodies ordered in diabetes diagnosis?

Answer 6

If in doubt wether T1DM or T2DM

75% of patients have GAD antibodies in T1DM

Question 7

What would you do if a test result comes back positive, but the patient is asymptomatic?

Answer 7

Repeat test

Question 8

When would you suspect T2DM in a patient?

Answer 8

• Persistent hyperglycaemia
• Present risk factors
• Evidence of insulin resistance

Question 9

What do results for pre-diabetes look like?

Answer 9

• HbA1c: 42-27 mmol/L
• Fasting glucose 6.1-6.9 mmol/L
  Impaired fasting glucose
• Plasma glucose at 2 hours 7.8-11.0 mmol/L
  Impaired glucose tolerance

Question 10

Name two differentials of DM

Answer 10

• Diabetes insipidus

- Hypercalcaemia

Question 11

What would you base a diagnosis of T1DM on?

Answer 11

Adult’s presenting with hyperglycaemia and may have 1+:
• Ketosis
• Rapid weight loss
• Age of onset <50 yrs
• Personal and/or family Hx of autoimmune disease

Question 12

When would you measure C-peptide for T1DM

Answer 12

• Atypical features
• Suspicion of monogenic diabetes
• Classification is uncertain

Question 13

When would you not rely on a HbA1c result for diagnosis?

Answer 13

• <18 yrs
• Pregnant women or women who are 2 months postpartum
• Symptoms of diabetes for <2 months
• Acutely ill people
• People taking medication that can cause hyperglycaemia
• Pancreatic damage
• HIV infection
• ESKD

Question 14

How do you manage T1DM?

Answer 14

- Insulin for life
      Individualised programme
- DAFNE
- Annual care planning review
- HbA1c every 3-6 months

Question 15

When would you offer self-monitoring of glucose to a patient?

Answer 15

• T1DM
• On insulin therapy
• Evidence of hypoglycaemic episodes
• Pregnancy/planning to become pregnant

Question 16

When would a patient take a blood glucose measurement?

Answer 16

• One before each meal

- One before bed

Question 17

What is the target for a patient when taking blood glucose measurements?

Answer 17

• 5-7 mmol/L on waking

* 4-7 mmol/ L before meals

Question 18

What is the aims for HbA1c?

Answer 18

• 48 mmol/mol
• 53 mmol/mol
  If drug-associated hypoglycaemia

Question 19

What could cause a rise in HbA1c?

Answer 19

• Stress
• Non-adherence/complacency
• Emerging from ‘honeymoon phase’
  Period where there is a very small amount of residual exogenous insulin secretion