Type 1 Diabetes

Question 1

What is type 1 diabetes?

Answer 1

absolute insulin deficiency

Question 2

What two factors result in the onset of T1DM?

Answer 2

• genetic susceptibility

- environmental trigger

Question 3

Name some environmental triggers

Answer 3

• Diet
• Environmental toxin
• Viral infection

Question 4

What autoantibodies are associated with T1DM?

Answer 4

Anti GAD
Anti IA2
Anti ZnT8

Question 5

Describe the progression from trigger to diagnosis

Answer 5

1. Exposure to trigger
2. Production of autoantibodies
3. Inflammation of beta cells (insulinitis)
4. Destruction of beta cells
5. Insulin deficiency

Question 6

What percentage of risk is related to genetics?

Answer 6

1/3

Question 7

If your parent has type 1 diabetes what is the chance of you developing it?

Answer 7

25%

Question 8

Describe the typical presentation of type 1 diabetes

Answer 8

‘toilet, thirst, thinner, tired’, usually presents with severe symptoms, often acute onset (30% kids have DKA at presentation)

Question 9

What investigations are carried out for suspected T1DM?

Answer 9

• random plasma glucose/2 hour OGTT plasma glucose >11
• fasting plasma glucose >6.1
• urinalysis (ketones)
• Blood test for autoantibodies

Question 10

Describe the test that portrays long term glucose control

Answer 10

HbA1c - glycosylated haemoglobin - haemoglobin is exposed to glucose over lifespan of RBC so reflects long term control (6-8 weeks)

Question 11

State three key aims of treatment

Answer 11

• prevent hyperglycaemia
• avoid hypoglycaemia
• reduce chronic complications

Question 12

What is the normal insulin physiology?

Answer 12

Insulin is secreted at a low basal rate which accounts for 50% of insulin produced. Post-prandial insulin is secreted in relation to post-meal glucose

Question 13

State the target HbA1c

Answer 13

48-59

Question 14

Name three short acting insulins

Answer 14

Humulin, Homolog, Novorapid

Question 15

Name two long acting insulins

Answer 15

lantus, lenevinir

Question 16

Name a mixed solution

Answer 16

Novomix

Question 17

What are the two options for insulin administration?

Answer 17

Biphasic & basal bolus

Question 18

Describe basal bolus administration

Answer 18

Take long acting before bed and then short acting before each meal. Good for young/active people with varied lifestyle.

Question 19

Describe bi-phasic insulin administration

Answer 19

2 injections of mixed insulin at breakfast & dinner - less flexible and requires regular diet & lifestyle

Question 20

What are the two general types of insulin used?

Answer 20

Human & Analogue (most commonly used in UK)

Question 21

State the target blood glucose levels

Answer 21

• 3.9 - 7.2 mmol/l pre meal

- <10mmol/l 1-2 hours after start of meal

Question 22

Describe advanced carbohydrate counting

Answer 22

synchronising the amount of insulin taken to amount of carbs consumed

Question 23

Who is suitable for ACC?

Answer 23

Patients with an insulin pump or on multiple daily injections

Question 24

How do insulin pumps work?

Answer 24

Deliver continuous short acting insulin (basal). Manually activated bolus of insulin is given to cover meals - calculated by carbohydrate counting

Question 25

What factors affect absorption/action of insulin?

Answer 25

• temperature
• injection site
• injection depth
• exercise

Question 26

Why is it important to rotate injection site?

Answer 26

To avoid lipohypertrophy which will mean insulin is not absorbed

Question 27

What is involved in the long term management of T1DM?

Answer 27

• HbA1c checks
• weight
• blood pressure
• renal function/lipids
• retinal screening
• foot risk assessment
• DKA/hypo monitoring