Treatment of Type 1 Diabetes

Question 1

describe the 1st stage in the development of type 1 diabetes

Answer 1

genetic predisposition- mutation making it more likely to develop type 1
- combination of genes and an environmental trigger that causes the development of the disease

Question 2

what are HLA/MHC molecules

Answer 2

• major histocompatibility molecules
  -make you more likely to develop type 1 diabetes
• when the body is exposed to bacteria, it is presented to these cells in the immune system
• in type 1, the wrong MHC molecule combines with environmental trigger

Question 3

what is insulitis

Answer 3

islets being invaded and destroyed by immune system
- leading to a drop in B cell mass

Question 4

what are B cells

Answer 4

• low antioxidant defences
• highly specialised cellular functions
• dependent on other cells within an islet
• Fas L (apoptosis regulating protein)/Fas R expression

Question 5

give examples of causes of type 1 diabetes

Answer 5

• genetics
• environment
• diet
• vaccination
• viral infections
• beta cell low defences

Question 6

what is diabetes distress

Answer 6

where diabetes management becomes overwhelming, feeling that the diabetes controls them

Question 7

what is diabetes burnout

Answer 7

feeling burnt out because of their diabetes
- can lead patient to stop taking care of their diabetes
- state of frustration and disillusionment with regards to diabetes

Question 8

what is the purpose of structured education programmes

Answer 8

• aim to increase the patients knowledge and understanding of the condition and to boost their skills and confidence with self management

Question 9

describe the 2nd stage in the development of type 1 diabetes

Answer 9

• insulitis and beta cell injury
  -beta cells start to get destroyed by apoptosis and beta cell mass drops
• autoantibodies to insulin produced

Question 10

what is the first sign of type 1 diabetes

Answer 10

insulitis- inflammation of insulin producing cells

Question 11

describe the 3rd stage in the development of type 1 diabetes

Answer 11

• pre diabetes stage
• loss of 1st phase insulin response

Question 12

describe the 4th stage in the development of type 1 diabetes

Answer 12

• diabetes stage
• where beta cell mass is done to around 10%
• newly diagnosed type 1 diabetes

Question 13

describe the properties of beta cells that make them vulnerable in the development of diabetes

Answer 13

1. low antioxidant defences
2. highly specialised cellular functions
3. dependent on other cells within an islet
4. FasL/FasR expression

Question 14

at what stage do patients start coming into the clinic for type 1 diabetes

Answer 14

some at pre diabetes stage, but most at diabetes stage

Question 15

what is the standardised insulin dose

Answer 15

100 units/ml

Question 16

what are the 4 most common insulin regimes

Answer 16

1. once daily injection- mixture of a very long acting and short acting analogues
2. twice daily injections- mixture of short and long acting insulin
3. multiple daily injections (before meals)- short acting insulin and one daily injection of long acting insulin
   - basal bolus
4. insulin pump- short acting insulin only

Question 17

describe the onset and duration of action of rapid acting insulins (lispro, aspart)

Answer 17

very fast onset of action but short duration of action

Question 18

describe the onset and duration of action of short acting insulins

Answer 18

slower onset of action and short duration of action (about 10 hours)

Question 19

describe the onset and duration of action of intermediate acting insulins

Answer 19

slow onset of action, but has a longer duration of action
- up to about 15 hours

Question 20

describe the onset and duration of action of long acting insulins (glargine, detemir)

Answer 20

very slow onset of action, long duration of action
- about 24 hours

Question 21

how can we work out how much insulin is needed for a meal

Answer 21

10g of carbohydrate= 1 unit of insulin

Question 22

what do patients need to be aware of when reading food labels

Answer 22

1. portion/serving size
2. total carbohydrate
3. raw or cooked
4. glycaemic index

Question 23

What is the NICE gold standard treatment

Answer 23

Basal bolus regime

Question 24

When would the basal bolus regime not be offered to children and young people diagnosed with type 1 diabetes

Answer 24

-If a child needs such a small dose that it is too difficult to get the dosing right
- if it is felt inappropriate to expect a child under 5 years to have 4 or more injections per day