TYPE 1 DIABETES

Question 1

What is Type 1 diabetes mellitus?

Answer 1

Insulin deficiency - destroyed beta-cells in islets of Langerhans

Question 2

When does Type 1 diabetes present?

Answer 2

Most commonly before adulthood

Question 3

What are the typical features of Type 1 Diabetes?

Answer 3

• Hyperglycaemia (>11 mmol/L)
• Ketosis
• Rapid weight loss
• BMI < 25 kg/m2
• Age < 50 years
• Family history of autoimmune disease

Question 4

Symptoms of diabetes

Answer 4

Toilet
Thirst
Tired
Thinner

4 T

Question 5

If a child with suspected T1DM
presents with symptoms, What signs can be strong indicators of T2DM and require further investigations?

Answer 5

• Family history of Type 2
  diabetes
• Obese at presentation
• Black or Asian family origin
• Show evidence of insulin resistance (e.g. Acanthosis nigricans)

Question 6

microvascular complications include

Answer 6

retinopathy
neuropathy
nephropathy

Question 7

macrovascular complications include

Answer 7

premature CVD
peripheral arterial disease
MI, stroke

Question 8

metabolic complications

Answer 8

DKA
hypoglycaemia

Question 9

target HbA1c for T1D

Answer 9

48mmol/mol (6.5%) or lower

Question 10

What are the HbA1c levels for normal, prediabetes and diabetes

Answer 10

Normal - Below 42 mmol/mol (6%)
Prediabetes - 42-47 mmol/mol (6-6.4%)
Diabetes - 48 mmol/mol (6.5% or more)

Question 11

What are the blood pressure targets for a diabetic patient with and without complications→

Answer 11

140/80 mmHG or 130/80 mmHG (with complications)

Question 12

What is the cholesterol target for a diabetic patient

Answer 12

Total cholesterol <4 mmol/L.

Question 13

What is the diagnostic test for Type 1 diabetes

Answer 13

Random blood glucose test

Question 14

What is the difference between the diagnostic test for Type 1 and Type 2

Answer 14

Type 2 is HbA1c and fasting blood glucose test

Question 15

What is the diagnostic test for Gestational diabetes

Answer 15

Oral glucose tolerance test

Question 16

Why is HbAlc useful in T1DM?

Answer 16

• It shows an average of glycaemic control in the past
  2-3 months
• It is a reliable predictor of microvascular and macrovascular complications
• Lower HbA1c = lower risk of
  long-term vascular complications

Question 17

How often should
HbA1c be measured in patients with type 1 diabetes?

Answer 17

3-6 m

Question 18

Blood glucose monitoring
Targets

Answer 18

TARGETS:
* 5-7 mmol/L on waking (fasting)
* 4-7 mmol/L fasting BG before meals at other times of the day
* 5-9 mmol/L 90 minutes after eating
* >5 mmol/L when driving

Question 19

waking (fasting)

Answer 19

5-7 mmol/L

Question 20

fasting BG before meals at other times of the day

Answer 20

4-7 mmol/L

Question 21

90 minutes after eating

Answer 21

5-9 mmol/L

Question 22

when driving

Answer 22

> 5 mmol/L

Question 23

How often should blood glucose be measured?

Answer 23

Monitored at least 4 x day
Before each meal and before bed

Question 24

all patients will require therapy with

Answer 24

insulin

Question 25

T1DM - first line treatment

Answer 25

Basal bolus regime
- Insulin determir bd
- Insulin aspart before meals