Type 1 Diabetes

Question 1

diabetes mellitus?

Answer 1

chronic condition with abnormally raised levels of blood glucose

Question 2

what does Type 1 result in?

Answer 2

absolute deficiency in insulin- may present in diabetic ketoacidosis

Question 3

type 2?

Answer 3

relative deficiency of insulin due to an excess of adipose tissue

Question 4

what may trigger type 1 diabetes?

Answer 4

coxsackie B and enterovirus

Question 5

classic triad of type 1?

Answer 5

polydipisia
polyuria
weight loss

diabetic ketoacidosis

Question 6

blood glucose ideally should be?

Answer 6

4.4- 6.1 mmol/L

Question 7

how does insulin work?

Answer 7

absorb glucose from blood,
muscle and liver cells to store it as glycogen

Question 8

what does glucagon do?

Answer 8

glycogenolysis
gluconeogenesis

Question 9

when do you get ketogenesis?

Answer 9

prolonged fasting

Question 10

in type 1 diabetes what can you get?

Answer 10

metabolic acidosis

Question 11

Key features about diabetic ketoacidosis?

Answer 11

ketoacidosis, dehydration potassium imbalance

Question 12

to combat the ketones the kidneys will produce?

Answer 12

bicarbonate

Question 13

what does insulin do?

Answer 13

drive potassium into cell, hence high serum potassium but total body potassium is low

Question 14

when insulin treat starts people may develop?

Answer 14

hypokalaemia, and so arrhythmias

Question 15

presentation of diabetic ketoacidosis?

Answer 15

hyperglycaemia
potassium imbalance
metabolic acidosis (low bicarbonate)
ketosis
dehydration

Question 16

symptoms of diabetic ketoacidosis?

Answer 16

polyuria, polydipsia, n/v, weight loss, actone smelling breath, dehydration, hypotension, altered consciousness, abdominal pain kussmal respiration (deep hyperventilation)

Question 17

diagnosing ketoacidosis requires 3 criterion?

Answer 17

hyperglycaemia ( above 11mmol/L)
ketosis (ketones above 3mmol/L)
acidosis (below 7.3)

Question 18

management of DKA?

Answer 18

F- fluids iv normal saline 1 litre first hour then 1 litre for 2 hours
I- insulin actrapid 0.1 units/kg/hour
G- glucose if below 14mmol/L
P- potassium
I- infection
C- chart fluid balance
K- ketones monitor alongside pH and bicarbonate

Question 19

dont stop fluids and insulin until?

Answer 19

ketosis, acidosis have resolved, they are eating/drinking, subcut insulin started

Question 20

key complications with treatment of DKA?

Answer 20

hypoglycaemia
hypokalaemia
cerebral oedema
pulmonary oedema

Question 21

normal rate of k infusion compared to DKA?

Answer 21

not exceed 10mmol/hour but in DKA can go up to 20

Question 22

autoantibodies in type 1?

Answer 22

anti-islet cell
anti- GAD
anti- insulin

serum c peptide is low with low insulin

Question 23

Long term management of type 1?

Answer 23

basal/bolus or pump

Question 24

injecting into same space can cause?

Answer 24

lipodystrophy- subcut fat hardens

Question 25

symptoms of hypoglycaemia?

Answer 25

sweating, tremor, irritability, hunger, dizziness pallor

Question 26

treatment of severe hypoglycaemia?

Answer 26

im glucagon, or iv dextrose

Question 27

macrovascular complication?

Answer 27

CAD, peripheral ischaemia (diabetic foot ulcers), stroke, HTN

Question 28

microvascular complications?

Answer 28

peripheral neuropathy, retinopathy, kidney disease glomerulosclerosis

Question 29

infection related complication?

Answer 29

UTI, pneumonia, skin and soft tissue, fungal infection oral and vaginal candidiasis

Question 30

diagnosis for type 1?

Answer 30

fasting glucose more than 7 or equal random glucose more or equal to 11.1

Question 31

diagnosis criteria for type 1?

Answer 31

ketosis age below 50 bmi below 25 rapid weight loss personal FH

Question 32

if doubt between type 1 and 2 investigation of choice?

Answer 32

c-peptide levels, diabetes- specific autoantibodies

Question 33

How often should HbA1c be monitored?

Answer 33

3-6 months 48 mmol/mol or lower

Question 34

self monitoring for type 1?

Answer 34

x4 a day

Question 35

blood glucose targets on waking and before meals?

Answer 35

waking- 5-7 before meals 4-7

Question 36

when to add metformin for type 1?

Answer 36

if bmi over equal to 25

Question 37

type of insulin?

Answer 37

1. offer multiple daily injection basal–bolus insulin regimens, rather than twice‑daily mixed insulin regimens, as the insulin injection regimen of choice for all adults 2. twice‑daily insulin detemir is the regime of choice. Once-daily insulin glargine or insulin detemir is an alternative 3. offer rapid‑acting insulin analogues injected before meals, rather than rapid‑acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes

Question 38

specific features of DKA?

Answer 38

kussmaul respiration (deep hyperventilation) acetone smelling breath