Type 1 Diabetes

Question 1

What is the normal range for blood glucose?

Answer 1

4.4-6.1mmol/l

Question 2

What is T1DM?

Answer 2

The pancreas stops being able to produce insulin

Question 3

What is DKA?

Answer 3

Inability to process glucose leads to initiation of ketogenesis. Levels of ketone acids build up and the blood becomes acidic (ketoacidosis)

Question 4

What is the presentation of DKA?

Answer 4

Hyperglycaemia
Dehydration
Ketosis
Metabolic acidosis
Potassium imbalance

Question 5

What are the symptoms of DKA?

Answer 5

Polyuria
Polydipsia
Nausea and vomiting
Acetone smell to breath
Dehydration and subsequent hypotension
Altered consciousness

Question 6

How do you diagnose DKA?

Answer 6

Hyperglycaemia (BG> 11)
Ketosis (ketone> 3)
Acidosis (pH< 7.3)

Question 7

What is the priority treatment of DKA?

Answer 7

Medical emergency
Fluid resuscitation- correct dehydration, electrolyte imbalance and acidosis
Insulin infusion

Question 8

What does FIG-PICK mean in DKA treatment?

Answer 8

Fluids- IV fluid resuscitation with normal saline
Insulin- insulin infusion
Glucose- dextrose infusion and BG monitoring
Potassium- monitor serum potassium
Infection- treat underlying triggers
Chart- fluid balance
Ketones- monitor blood ketones

Question 9

What is the long term management of T1DM?

Answer 9

Patient education
Subcutaneous insulin regimes
Monitor daily carbohydrate intake
Monitor BG on waking, at each meal and before bed
Monitor and manage complications

Question 10

What is lipodystrophy?

Answer 10

Caused by injecting insulin into the same spot
Subcutaneous fat hardens and patients don’t absorb insulin properly from this spot in the future
Patient should cycle their injection sites!

Question 11

What are the short term complications of type 1 diabetes?

Answer 11

Hypoglycaemia
Hyperglycaemia (and DKA)

Question 12

What are the symptoms of a hypo?

Answer 12

Tremor
Sweating
Irritability
Dizziness
Pallor

Reduced consciousness, coma, death

Question 13

What is the treatment of a hypo?

Answer 13

Rapid acting glucose e.g. coke
Slow acting carbohydrates e.g. toast

Severe- IV dextrose and intramuscular glucagon

Question 14

What are the long term complications of type 1 diabetes?

Answer 14

Macrovascular- CVD, stroke, HTN, peripheral ischaemia
Microvascular- retinopathy, nephropathy, neuropathy
Infection related- UTI, pneumonia, fungal infections

Question 15

What causes macrovascular complications?

Answer 15

Dyslipidaemia:
- HDL (good) cholesterol lowered
- LDL (bad) cholesterol increased
- TAGs increased

Causes plaque formation and endothelial dysfunction

Question 16

What are the types of retinopathy?

Answer 16

Non proliferative (retinal capillary or platelet dysfunction)
Proliferative (retinal ischaemia, new blood vessel formation)

Question 17

What is the treatment of retinopathy?

Answer 17

Improve glycaemic control
Laser photocoagulation for proliferative

Question 18

What are the features of nephropathy?

Answer 18

Microalbuminuria
Glomerular hypertension

Question 19

What is the treatment of nephropathy?

Answer 19

Screening and treatment of albumin
ACEIs, ARBs, renin inhibition
HTN control
Dialysis

Question 20

What are the types of neuropathy?

Answer 20

Sensory
Motor
Autonomic

Question 21

How do we monitor T1DM?

Answer 21

HbA1C
Capillary BG
Flash glucose monitoring

Question 22

What is HbA1c?

Answer 22

Glycated haemoglobin
Reflects average glucose level over the last 3 months because RBCs have a lifespan of 3-4 months
Measured every 3-6 months