Type 1 Diabetes

Question 1

What is Type 1 Diabetes Melitus

Answer 1

Insulin deficiency caused by auto-immune beta cell damage

Question 2

When does Type 1 generally manifest

Answer 2

<30 years

Except for Latent Autoimmune Diabetes in Adults (LADA)

Question 3

What is LADA

Answer 3

Slow burning with slow progression to insulin deficiency
Occurs as an adult
Can be mistaken as Type 2
-Lean build

Question 4

What are some autoimmune associations with Type 1 (risk factors)

Answer 4

Auto immune thyroid
Coeliac Disease
Addison’s (high cortisol)
Pernicious Anaemia

Question 5

What environmental factors are associated with Type 1

Answer 5

Diet
Enteroviruses
Vitamin D deficiency
Clean environment

Question 6

What are the clinical values for Diabetes Melitus

Answer 6

Random plasma glucose >11mmol/l
Fasting plasma glucose >7mmol/l
No symptoms – GTT fasting >7
HbA1c >48mmol/mol

Question 7

What are the common symptoms of Diabetes Melitus

Answer 7

Polydipsia
Polyuria 
Weight loss
Fatigue 
Hunger 
Pruritis vulvae
Balanitis 
Blurred vision

Question 8

What are the features of Type 1

Answer 8

Onset in childhood/ adolescence
Lean build
Acute onset of osmotic symptoms
Prone to ketoacidosis
High levels of islet autoantibodies

Question 9

What are the features of newly diagnosed Type 1

Answer 9

Weight loss
Short history of symptoms
Moderate or large urinary ketones

Question 10

What are the genetic associations of Type 1 DM

Answer 10

HLA- DR3/DQ2

HLA- DR4-DQ8

Question 11

What is the pathology of Type 1 DM

Answer 11

Autoantibodies destroy B cells of Islet of Langerhans
Insulin deficiency and Glycogen breakdown
Hyperglycemia and Glycosuria

Question 12

What is the treatment of Type 1 DM

Answer 12

First line = Insulin injected subcutaneously (aware patient)

If patient is unaware give Insulin pump

Question 13

What is the major complication of T1DM

Answer 13

Ketoacidosis

Question 14

What are the investigations for Type 1 DM

Answer 14

Urine dipstick = Glycosuria
Resting Plasma Glucose >11.1mmol/L
HbA1c >48mmol/L >6.5%

Question 15

What causes Ketoacidosis

Answer 15

Untreated T1DM

Question 16

What is the Patho for Ketoacidosis

Answer 16

No insulin production = increased gluconeogenesis and decreased tissue uptake = HYPERGLYCEMIA
Osmotic diuresis causes dehydration
Lipolysis induced increasing Fatty Acids so more Acetyl CoA producing ketones = Acidosis

Question 17

What are the investigations for ketoacidosis

Answer 17

Hyperglycemia? >11.1 mmol/L RPG
Ketonaemia? >3mmol/L plasma ketones
Acidosis? pH <7.35 or HCO3 <15mmol/L
Urine dipstick = Glycosuria/ketonuria

Question 18

What are the complications of Ketoacidosis

Answer 18

Cerebral oedema
Coma
Pneumonia
Death

Question 19

What is the management of Ketoacidosis in an aware patient and not vomiting

Answer 19

Oral and Subcutaneous Insulin Injection

Question 20

Does Ketoacidosis present with fever and hyperglycemia

Answer 20

Fever = no
Hyperglycemia = sometimes

Question 21

What is the Presentation for DKA

Answer 21

Acetone fruity breath
Kussmaul Breathing (sigh)
Hypovolemic shock
Dehydration
Vomiting
Abdominal pain
Coma

Question 22

What is the management of Ketoacidosis in a vomiting, confused patient

Answer 22

1st) IV 0.9% NaCl
- 0.1 Insulin infusion
- Potassium

Question 23

What is the management of Ketoacidosis in a coma patient

Answer 23

ABCDE for resuscitation

Question 24

Who is basal-bolus insulin appropriate for

Answer 24

Patients who have the ability to regulate and manage their insulin///i.e young people

Question 25

What kind of Hypersensitive is Type 1 DM

Answer 25

T4

Question 26

What is the difference between basal and bolus insulin

Answer 26

Basal = Long and slow (for the day)
Bolus = fast and short (For a meal)