Type 1 diabetes

Question 1

What is the definition of type 1 diabetes?

Answer 1

Chronic high blood glucose due to no insulin production

Random plasma glucose >11mmol/L

Question 2

How common is type 1 diabetes?

Answer 2

6% of the UK population

Question 3

What are the risk factors/aetiology of type 1 diabetes?

Answer 3

• Adolescent onset
• Other autoimmune diseases
• Genetic/family history (HLA antibodies)
• Northern European
• Exposure to dietary constituents?
• Enterovirusus?
• Vaccinations?
• Clean environment?

Question 4

What are the signs/symptoms of type 1 diabetes?

Answer 4

• Polyuria
• Polydipsia (excessive thirst)
• Unexplained weight loss
• Visual blurring/Diabetic retinopathy
• Arterial disease
• Polyneuropathy – tingling and numbness in the feet
• Genital thrush
• Erectile dysfunction
• Lethargy
• Ketoacidosis – breath may smell
• Venous glucose >7mmol/L when fasting or >11mmol/L when random
• Acanthosis nigrcans – severe insulin resistance

Question 5

What investigations should be conducted for suspected type 1 diabetes?

Answer 5

• U&Es
• Albumin:creatinine ratio
• TFTs
• Lipid profile
• HbA1c ->48mmol/mol = diabetes
• Blood glucose finger prink
• Diabetic specific autoantibody titres/C-peptide – only if atypical features (e.g. >50), clinical suspicion of monogenic form of diabetes, classification uncetrain
• Glucose tolerance test
• Serological testing for coeliac disease – in order to exclude

Question 6

What should you tell patients with type 1 diabetes?

Answer 6

Do not drive and inform DVLA during hypoglycaemic spells

Question 7

What are the surgical treatments for type 1 diabetes?

Answer 7

• Islet/pancreas transplant

Question 8

What are the pharmacological treatments for type 1 diabetes?

Answer 8

• Insulin – normally long acting in the morning the rapid acting after meals
• Exanatide – alternative to insulin. Promotes insulin release, inhibits glucagon release, reduces appetite and delays gastric emptying
• Statin
• Blood pressure control (if required)

Question 9

What are the non pharmacological treatments for type 1 diabetes?

Answer 9

• Foot care
• Eating a healthy, balanced diet
• Maintaining a healthy weight
• Smoking cessation
• Drinking alcohol in moderation
• Exercising regularly
• Checking glucose levels regularly