Type 1 diabetes

Question 1

It is an autoimmune disease: True or False

Answer 1

True

Question 2

Are there beta cells present?

Answer 2

No

- therefore no insulin is produced

Question 3

Definition

Answer 3

Autoimmune condition where the body is unable to produce it’s own insulin
Absolute insulin deficiency

Question 4

Cause

Answer 4

No insulin so glucose homeostasis cannot be maintained

Question 5

Who gets it?

Answer 5

Young children

Pre-puberty

Question 6

Are you more likely to develop Type 1 diabetes if your mother OR father suffers from it?

Answer 6

Father

Question 7

Pathogenesis

Answer 7

Destruction of pancreatic beta cells

Presence of anti-GAD or anti-islet cell antibodies

Question 8

Clinical features

Answer 8

Acute onset 
Thirst (polydypsia)
Polyuria (increased frequency of urination) 
Bed wetting in children 
Tiredness 
Severe weight loss
Increased appetite 
Blurred vision 
Thrush

Question 9

Discriminatory tests (3)

Answer 9

Presence of anti-GAD or anti-islet antibodies
Ketones
C-peptide

Question 10

Investigations

Answer 10

Fasting blood glucose 
Glucose tolerance test
Random blood glucose (fingerprick)
HbA1c 
ABG 
Urinalysis 
Antibodies

Question 11

Fasting blood glucose - normal level

Answer 11

6mM and below

Question 12

Fasting blood glucose - T1DM level

Answer 12

7mM and above

Question 13

Glucose tolerance test - normal level

Answer 13

7.7mM and below

Question 14

Glucose tolerance test - T1DM level

Answer 14

11.1mM and above

Question 15

Random blood glucose (fingerprick) - T1DM level

Answer 15

11. 1mM and above

- this test is just an indicator, it is not diagnostic

Question 16

HbA1c - normal level

Answer 16

41mM and below

Question 17

HbA1c - T1DM level

Answer 17

48mM and above

Question 18

What is the target HbA1c level for most T1DM sufferers?

Answer 18

53mM

Question 19

Urinalysis findings

Answer 19

Glucose

Ketones

Question 20

Management

Answer 20

Insulin

Question 21

Insulin injection - slow acting - administration time

Answer 21

Injected at night time which acts in the background to keep glucose levels down overnight

Question 22

Insulin injection - short acting - administration time

Answer 22

Injected 15 mins before meal times in order to combat the influx of glucose during meals

Question 23

Insulin injection - common injection site locations

Answer 23

Abdomen
Upper outer thigh
Buttocks
Upper outer arm

Question 24

Insulin injection - injection site movement

Answer 24

Use different injection site for each injection and always change the insulin syringe for each injection

Question 25

Insulin injection - complications

Answer 25

Lipohypertrophy - due to repeated injections in the same injection site

Question 26

Analogue long acting insulin examples (2)

Answer 26

Glargine

Detemir

Question 27

Human short acting insulin example (1)

Answer 27

Actrapid

Question 28

Human long acting insulin example (1)

Answer 28

Insulatard

Question 29

Analogue short acting insulin example (2)

Answer 29

Humalog

Novarapid

Question 30

What do you do if leaking of insulin occurs from the injection site?

Answer 30

Do not administer another dose of insulin as it may result in an overdose

Question 31

Insulin pump - administration

Answer 31

Delivers subcutaneous insulin

Patient delivers boost of short acting insulin to coincide with mealtimes

Question 32

Insulin pump - who gets it?

Answer 32

Patients who struggle to achieve normoglycaemia using injections

Question 33

IV insulin - who gets it?

Answer 33

Acutely ill patients
DKA
Fasting patients (nil by mouth)

Question 34

IV insulin - administration

Answer 34

Continuous basal bolus along with IV infusion

Question 35

Associated conditions

Answer 35

DKA
CF
Auto-immune conditions: coeliac disease, thyroid disease

Question 36

Review appointment procedure

Answer 36

Measure weight, height = BMI 
BP
Bloods
Retinal screening 
Foot risk assessment