Type 1 Diabetes

Question 1

What is the definition of T1DM?

Answer 1

T4 hypersensitivity
Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency

Question 2

What is the epidemiology of T1DM?

Answer 2

Young patient, lean, north European decent (Finland)
Presents ages 5-15
10% of diabetes is type 1
LADA-latent autoimmune diabetes in adults

Question 3

What are some risk factors for T1DM?

Answer 3

Northern European- Finnish
Family history: HLA-DR3-DQ2 or HLA-DR4-DQ8
Idiopathic
Other autoimmune diseases
Environmental infection (viral)

Question 4

What is the pathology behind T1DM?

Answer 4

Autoimmune antibodies attack B cells in the islets of langerhans - insulin deficiency- hyperglycemia

Low cellular glucose - continuous breakdown of glycogen from liver (gluconeogenesis) producing glucose + ketones (goycosuria and ketonuria)

Hyperkalemia - even though total body K+ decreased (insulin shoves K+ into cells via Na+/K+ ATPases)

Question 5

Symptoms/classic presentation of T1DM?

Answer 5

Lean young patient with classic triad - POLYDIPSIA (thirsty), POLYURIA -NOCTURIA (urinate a lot 3L<), POLYPHAGIA (hungry)
Weight loss (BMI<25)
Glycosuria

Question 6

What is the pathophysiology of the triad symptoms?

Answer 6

Polyuria - blood glucose increases, reaches 10mmol/L = no longer absorb glucose therefore get thirsty (polydipsia) & urinate a lot to try remove excess glucose)

Question 7

What tests can you do to diagnose T1DM?

Answer 7

Random plasma glucose (RPG) - glucose taken randomly
Normal = <11.1 mmol/L
T1DM = >11.1 mmol/L

Fasting plasma glucose (FPG) - glucose taken after no eating 8+ hours
Normal = <7mmol/L
T1DM = >7mmol/L

HbA1C - glucose attached to haemoglobin takes 3 months to get new readings
T1DM = >48mmol/L or >6.5%

Question 8

Is there anything that can be done to prevent onset of disease?

Answer 8

No prediabetes - no lifestyle modifications will affect this diabetes developing

Question 9

What is the treatment for T1DM?

Answer 9

Basal insulin -longer acting, to maintain stable insulin level all day

Bolus insulin - faster acting, 30 mins before preprandial for insulin spike

Question 10

Which diagnostic test is better and why?

Answer 10

RPG and FPG are better initially (results instantly)
HbA1C is slower but a very good marker - most accurate

Question 11

Name the insulins you can get for:
Rapid
Short
Intermediate
Long

Answer 11

Novorapid, aspart

Regular insulin

NPH

Glargine, determir

Question 12

What are some secondary causes of T1DM?

Answer 12

Acromegaly and cushings
Haematochromatosis
Thiazides / corticosteroids