Type 1 Diabetes

Question 1

What are possible environmental triggers for type 1 diabetes?

Answer 1

viral infection; maternal factors; weight gain; vitamin D deficiency; dietary factors; environmental toxins

Question 2

What antigens with which auto-antibodies are formed against in type 1?

Answer 2

glutamine acid decaroxylase
islet-antigen 2
insulin
ZnT8 transporter

Question 3

What are the auto-antibodies in type 1?

Answer 3

GAD65Ab
IA-2Ab
IAA
ZnT8Ab

Question 4

What are the accelerating factors for diabetes?

Answer 4

infection; insulin resistance; puberty; diet/weight; stress

Question 5

What are the features of type 1 diabetes?

Answer 5

raised glucose; ketones; decreased insulin; decreased beta cell mass; decreased C-peptide

Question 6

What are the typical presenting symptoms of type 1 diabetes?

Answer 6

polyuria (enuresis in children); polydipsia; weight loss; fatigue and somnelence; blurred vision; candidal infection

Question 7

What is the ideal range of HbA1c?

Answer 7

48 to 58 mmol/mol

Question 8

What are the two phases of insulin secretion?

Answer 8

rapid phase of pre-formed insulin and slow phase over 1 to 2 hours

Question 9

What vessel is insulin secreted into?

Answer 9

portal vein

Question 10

What type of diabetes should you suspectin a patient under the age of 6?

Answer 10

monogenic diabetes

Question 11

What is LADA?

Answer 11

latent onset diabetes of adulthood

Question 12

How is a diagnosis of LADA made?

Answer 12

the presence of elevated levels of pancreatic auto-antibodies in patients who do not initially require insulin

Question 13

Who gets LADA?

Answer 13

young adults 25-40; male; usually non-obese

Question 14

How many patients with CF get diabetes?

Answer 14

more than 25% will have a 20 years

Question 15

What is Wolfram syndrome?

Answer 15

DIDMOAD
Diabetes Insipidus
Diabetes MEllitus
Optic Atrophy
Deafness

Question 16

What are the features of bardet-beidl syndrome?

Answer 16

very obese; polydactyly; hypogonadal; visual impairment; hearing impairment; mental retardation; diabetes

Question 17

What are the associated auto-immune conditions with type 1?

Answer 17

thyroid disease; coeliac disease; pernicious anaemia; addisons disease; IgA deficiency

Question 18

How is coeliac disease diagnosed?

Answer 18

anti-TTG antibodies; duodenal biopsy

Question 19

What are the symtoms of thyroid disease?

Answer 19

wegith change; deterioration in HbA1c; hypoglycasemia

Question 20

What is polyglandular endocrinopathy?

Answer 20

The polyglandular autoimmune syndromes (PAS) form
different clusters of autoimmune disorders and are
rare endocrinopathies characterized by the coexistence
of at least two glandular autoimmune mediated
diseases

Question 21

What are the symptoms of hypoglycaemia?

Answer 21

pallor; sweating; tremor; palpitations; confusion; nausea; hunger

Question 22

What are the symtpoms of hyperglycaemia?

Answer 22

thrist; tiredness; blurred vision; weight loss; polyuria; nocturia; fungal infections

Question 23

What percentage of insulin produced does the basal rate of insulin account for?

Answer 23

50%

Question 24

Give examples of rapid-acting analogues?

Answer 24

humalog; novorapid; apidra

Question 25

Give examples of long acting analogues?

Answer 25

lantus; levemir

Question 26

How should most people with type 1 diabetes be treated?

Answer 26

with MDI or CSII

Question 27

What is the initial amount of insulin given to a patient?

Answer 27

0.3units/kg of body weight

Question 28

What is the target for blood glucose before a meal?

Answer 28

3.9-7.2

Question 29

What is the blood glucose target 1-2 hours after beginning of meal?

Answer 29

<10mmol/l

Question 30

How long do insulin analogues take to act?

Answer 30

10-15 minutes

Question 31

What is onset of action of soluble insulin?

Answer 31

30-60 minutes

Question 32

What is advanced carbohydrate counting?

Answer 32

synchronising the amount of insulin to amount of carbohydrate consumed

Question 33

What do insulin pumps deliver?

Answer 33

continuous administration of short acting insulin subcutaenously

Question 34

How is glycated haemoglobin formed?

Answer 34

by non-enzymatic glycation of haemoglobin on exposure to glucose

Question 35

What factors can affect insulin absorption/action?

Answer 35

tempreature; injection site; injection depth; exercise

Question 36

Do you stop insulin if patient has a hypo?

Answer 36

No- treat hypo and administer insulin as normal

Question 37

What should also be given with IV insulin infusions?

Answer 37

glucose

Question 38

Who is given IV insulin?

Answer 38

DKA; in hyperosmolar hyperglycaemic state; acute illness; fasting patients who are unable to tolerate oral intake

Question 39

What is the blood glucose level aimed for with IV insulin?

Answer 39

5-12 mmol

Question 40

How often should patients on IV insulin have their blood glucose checked?

Answer 40

hourly