Type 1 diabetes

Question 1

What is type 1 DM?

Answer 1

Type 1 diabetes mellitus is a state of absolute insulin deficiency caused by an environmental trigger in a genetically susceptible person causing an autoimmune reaction to pancreatic ß-cells

Question 2

What is the risk of developing T1DM if both parents have it?

Answer 2

30%

Question 3

What are some risk factors for developing T1DM?

Answer 3

• Age - peak 10-14
• Sex - M=F in young, M>F after puberty
• Genotype - HLA around 50%
• Season of birth (In some countries e.g. Sweden)

Question 4

What are some triggers than can begin symptoms of T1DM?

Answer 4

• Viral infection
• Maternal factors
• Weight gain
• Vitamin D

Question 5

What are some autoantibodies responsible for ß-cell destruction in T1DM?

Answer 5

• IA-2 (Islet antigen 2)
• IAA (Insulin auto-antibody)
• GAD-65 (Glutamic acid decarboxylase)
• Zn T8

Question 6

What usually causes symptoms in T1DM?

Answer 6

Hyperglycaemia

Question 7

What are some symptoms of T1DM?

Answer 7

• Polyuria
• Enuresis in children (Bedwetting)
• Thirst
• Polydipsia (Drinking lots of water)
• Blurred vision (High blood glucose causes lense shrinking)
• Genital thrush
• Fatigue
• Weight loss

Question 8

What will blood testing show in T1DM?

Answer 8

• Raised glucose and HbA1c
• Raised ketones
• Decreased insulin
• Reduced C-peptide
• GAD/IA2 antibodies

Question 9

What is the pre-meal target for blood sugar in T1DM management?

Answer 9

4 - 5.5 mmol/L

Question 10

What is the 2hr post-meal target for blood sugar in T1DM management?

Answer 10

6 - 6.5 mmol/L

Question 11

What will annual T1DM reviews measure?

Answer 11

• Weight
• Blood pressure
• HbA1c
• Renal function
• Lipids

Question 12

How is T1DM managed in labour?

Answer 12

IV insulin and IV dextrose to maintain a good balance of blood sugar

Question 13

What are the 2 types of insulin dose given in T1DM management?

Answer 13

Basal (Given once daily)
Prandial (With meals)

Question 14

What are the 2 types of prandial insulin injection?

Answer 14

Insulin analogues
Soluble insulin

Question 15

What are some examples of insulin analogues (Prandial)?

Answer 15

• Insulin aspart (NovoRapid)
• Lispro (Humalog)
• Glulisine (Apidra)

Question 16

What are some examples of soluble insulin (Prandial)?

Answer 16

• Actrapid
• Humalin S

Question 17

How long does it usually take for insulin analogues to work?

Answer 17

10-15 minutes

Question 18

When is the peak of action of insulin analogues?

Answer 18

After 60-90 minutes

Question 19

How long do insulin analogues last?

Answer 19

4-5 hourd

Question 20

How long does it take for soluble insulin to work?

Answer 20

30-60 minutes

Question 21

When is the peak of action of soluble insulin?

Answer 21

2-4 hours

Question 22

How long does soluble insulin last?

Answer 22

5-8 hours

Question 23

What are the 2 types of basal insulin?

Answer 23

Isophane insulin
Analogue basal insulin

Question 24

What are some examples of isoprene insulin?

Answer 24

• Insulatard
• Humulin I

Question 25

What are some examples of analogue basal insulins?

Answer 25

• Lantus (Glargine)
• Levemir (Determir)

Question 26

How long does isoprene insulin last?

Answer 26

12 hours (Peak at 4-6 hours)

Question 27

What is LADA?

Answer 27

Latent autoimmune disease in adults - A late onset T1DM, which presents as type 2

Question 28

What syndrome can cause T1DM?

Answer 28

Wolfram syndrome

Question 29

What is Wolfram syndrome and what does it cause?

Answer 29

This is a rare genetic disorder characterised by 5 main complications (DIDMOADN):

• Diabetes Insipidus
• Diabetes Mellitus T1
• Optic atrophy
• Deafness
• Neurological anomalies