Type 1 Diabetes

Question 1

What should normal blood sugar levels be?

Answer 1

4-5.6mmol/L

Question 2

What is the main difference between type 1 & type 2 diabetes?

Answer 2

Type 1: insulin dependent (genetics)

Type 2: non-insulin dependent (or insulin independent) (obesity/drug related)

Question 3

What are the main features of someone diagnosed with type 1 diabetes?

Answer 3

Family history
<50 years old
BMI <25kg/m squared
Symptoms of hyperglycaemia

Question 4

Why are diabetics more prone to candida infections?

Answer 4

Because they are excreting lots of sugar in their urine which is the appropriate environment for bacterial growth to occur.

Question 5

What are the symptoms of hyperglycaemia/undiagnosed T1DM?

Answer 5

Polyuria
Thirst
Excessive weight loss
Ketones in blood/urine
Lethargy

Question 6

What are the 3 investigations for diabetes?

Answer 6

Fasting glucose test
Random glucose test on 2 separate occasions
OGTT - oral glucose tolerance test

Question 7

What is the cut off point for diagnosing diabetes using the fasting and random glucose tests?

Answer 7

Fasting = > 7mmol/L
Random = >11.1mmol/L on 2 separate occasions

Question 8

How can the risk of CV events be lowered in diabetic patients?

Answer 8

By adding an ACEi (nephroprotective/preserves heart function )
By adding a lipid lowering agent, e.g. statin

Question 9

What should HbA1C levels normally be (and is also the target for type 1 diabetics)?

Answer 9

<48mmol/mol (<6.5%)

Question 10

Why is the HbA1C of a diabetic patient checked every 3 months?

Answer 10

Because that is the average lifespan of a normal RBC

Question 11

Why cant insulin be taken by mouth? Which route is it given it?

Answer 11

Because it includes amino acids which will be digested by the stomach.
Insulin is hence given by subcutaneous injection, or IV

Question 12

What is the ideal insulin regimen for a type 1 diabetic?

Answer 12

Basal-bolus

Question 13

What are some examples of rapid acting human insulin analogues?
When are they taken?

Answer 13

Insulin aspart - NovoRapid
Insulin lispro - Humalog
Insulin glulisine - Apidra

They are taken shortly before/after a meal

Question 14

What is the onset of action of rapid acting insulin?

Answer 14

15mins

Question 15

What are some examples of intermediate insulins?
When are they taken?

Answer 15

Isophane insulin - Humulin I, or Insulatard

They are taken twice a day for stable basal levels, if the patients lifestyle is regular.

Question 16

What is the onset of action of intermediate insulins?

Answer 16

1-2h

Question 17

What are some examples of longer acting insulins?
When are they taken?

Answer 17

Insulin glargine - Lantus, or Toujeo
Insulin detemir - Levemir

They are taken once a day

Question 18

What is the duration of action of long acting insulins?

Answer 18

36h

Question 19

What are some examples of biphasic insulins (mixed)?

Answer 19

NovoMix 30
Humalog Mix 25 or Mix 50
Humulin M3

Question 20

Which patients would benefit from a CSII (continuous subcutaneous insulin infusion) pump?

Answer 20

<12 years old who cannot tolerate injections
If the patients HbA1c is >8.5%
Those with multiple injection regimens
Those suffering from many hypos

Question 21

What ratio is measured nowadays which monitors for diabetic nephropathy?

Answer 21

Albumin/creatinine ratio (ACR)

Question 22

What should a type 1 diabetics blood sugar be before they drive?

Answer 22

> 5mmol/L

Question 23

What regular checks are required for all diabetic patients?

Answer 23

Foot checks (neuropathy)
Eye checks (retinopathy)
HbA1c every 3 months
ACR (nephropathy)