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Y3 GP: Diabetes > Type 1 Diabetes > Flashcards

Type 1 Diabetes Flashcards

1
Q

What is type 1 diabetes?

A

A metabolic disorder characterised by hyperglycaemia due to absolute insulin deficiency

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2
Q

Briefly describe the pathophysiology of type 1 diabetes

A

Due to destruction of pancreatic beta cells mostly by immune-mediated mechanisms

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3
Q

What are the risk factors for type 1 diabetes?

A
  • Geographic region
  • Genetic predisposition
  • Infectious agents
  • Dietary factors
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4
Q

What are the signs of type 1 diabetes?

A
  • Tachypnoea
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5
Q

What are the symptoms of type 1 diabetes?

A
  • Polyuria
  • Polydypsia
  • Unexplained weight loss
  • Blurred vision
  • Nausea and vomiting
  • Abdominal pain
  • Lethargy
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6
Q

What age group is most commonly diagnosed with type 1 diabetes?

A

Usually presents in childhood or adolescence→ typical age 5 to 15 years

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7
Q

What investigations should be ordered for type 1 diabetes?

A
  • Random plasma glucose
  • Fasting plasma glucose
  • 2-hour plasma glucose
  • Plasma or urine ketones
  • HbA1c
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8
Q

Why investigate random plasma glucose? And what may this show?

A
  • Confirms diagnosis in the presence of symptoms of polyuria, polydipsia, and unexplained weight loss
  • ≥11 mmol/L
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9
Q

Why investigate using fasting plasma glucose? And what may this show?

A
  • ≥6.9 mmol/L
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10
Q

Why investigate using 2-hour plasma glucose? And what may this show?

A
  • ≥11 mmol/L
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11
Q

Why investigate using plasma or urine ketones? And what may this show?

A
  • In the presence of hyperglycaemia suggest type 1 diabetes also assess for diabetic ketoacidosis
  • Medium or high quantity
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12
Q

Why investigate using HbA1c? And what may this show?

A
  • Reflects degree of hyperglycaemia over the preceding 3 months
  • ≥48 mmol/mol (≥6.5%)
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13
Q

Which definitive test can be used to differentiate between type 1 or type 2 diabetes? And why?

A

C-peptide is a byproduct formed when pro-insulin is processed to insulin. Therefore, its levels reflect insulin production. Half life of C-peptide is 3 to 4 times longer than that of insulin.

Low or undetectable C-peptide level indicates absence of insulin secretion from pancreatic beta cells.

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14
Q

Briefly describre the treatment for type 1 diabetes

A
  • 1st line: basal-bolus insulin regime
  • Adjunct: pre-meal insulin correction dose
  • Adjunct: amylin analogue
  • 2nd line: fixed insulin regime
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15
Q

What is the target HbA1c? And why is this important?

A

HbA1c level of 48 mmol/mol (6.5%) or lower to minimize the risk of long-term vascular complications

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16
Q

How often should HbA1c be measured?

A

Every 3-6 months

17
Q

What are the complications of type 1 diabetes?

A
  • Diabetic Ketoacidosis (DKA)
  • Hypoglycaemia
  • Retinopathy
  • Diabetic kidney disease
  • Peripheral or autonomic neuropathy
  • Cardiovascular disease
18
Q

What differentials should be considered in type 1 diabetes?

A
  1. Type 2 diabetes
19
Q

How does type 1 diabetes and type 2 diabetes differ?

A
  • Differentiating signs and symptoms: typically, signs of insulin resistance (such as acanthosis nigricans) should be sought and in their absence clinical suspicion of type 1 diabetes is greater. Signs of more marked insulin deficiency (for example, glycaemic lability as well as susceptibility to ketosis) raise suspicion of type 1 diabetes. Older age and slow onset, obesity, a strong family history, absence of ketoacidosis, and initial response to oral anti-hyperglycaemic drugs are typical of type 2 diabetes.
  • Differentiating investigations: C-peptide present and autoantibodies absent.
20
Q

How should cardiovascular risk be managed in type 1 diabetes?

A

Assess the following cardiovascular risk factors annually:

  • Lifestyle (including smoking status)
  • Waist circumference
  • Blood glucose control
  • BP
  • Albuminuria
  • Full lipid profile
  • Family history of CVD
21
Q

Should aspirin be offered for prevention of CVD in type 1 diabetes?

A

Do not routinely offer aspirin for the primary prevention of CVD. Decisions about antiplatelet treatment will usually be made by, or in consultation with, secondary care.

22
Q

What is the threshold BP for starting anti-hypertensives if no albuminuria or features of the metabolic syndrome are present?

A

The threshold for starting antihypertensive treatment in an adult with type 1 diabetes is blood pressure greater than or equal to 135/85 mmHg.

23
Q

What is the first line treatment for hypertension in type 1 diabetes?

A

Renin-angiotensin system blocking drugs:

  • Offer an angiotensin-converting enzyme (ACE) inhibitor, provided there are no contraindications
  • If an ACE inhibitor is not tolerated, offer an angiotensin-II receptor antagonist (AIIRA) if appropriate
24
Q

Briefly describe the use of lipid modification therapy in type 1 diabetes

A

Do not use a risk assessment tool to assess cardiovascular disease (CVD) risk in people with type 1 diabetes.

  • For people with type 1 diabetes who do not have established CVD→ offer statin treatment with atorvastatin 20 mg for the primary prevention of CVD if the person:
    • Is older than 40 years of age;
    • Has had diabetes for more than 10 years;
    • Has established nephropathy;
    • Has other CVD risk factors (such as obesity and hypertension).
  • For people with type 1 diabetes who have established CVD→ advise statin treatment with atorvastatin 80 mg for the secondary prevention of CVD.
25
Q

What are the macrovascular complications of diabetes?

A
  • Development of atherosclerosis, which increases the risk of cardiovascular diseases (CVDs), such as myocardial infarction, heart failure, stroke, and peripheral arterial disease (for example intermittent claudication)
26
Q

What are the microvascular complications of diabetes?

A
  • Nephropathy- diabetic kidney disease is caused by damage to small blood vessels in the kidneys
  • Retinopathy- diabetic retinopathy is caused by small blood vessel damage to the retina, leading to progressive loss of vision and possible blindness
  • Neuropathy- diabetes causes nerve damage through different mechanisms, including direct damage by the hyperglycemia and decreased blood flow to nerves by damaging small blood vessels
27
Q

At every diabetic review appointment, what parameters should be assessed?

A
  • HbA1c
  • Height, weight, waist circumference and BMI
  • Assess for depression, anxiety, and eating disorders
  • Check smoking status
  • Monitor for neuropathy and associated complications, including erectile dysfunction, neuropathic pain, autonomic neuropathy, and gastroparesis
28
Q

In a patient with type 1 diabetes, what complications should be assessed yearly?

A
  • Check injection sites and address any injection site problems
  • Assess for cardiovascular risk factors, including smoking status, waist circumference, blood glucose control, blood pressure, full lipid profile, and family history of cardiovascular disease
  • Ensure the person is screened for eye disease, kidney disease, and foot problems
  • Ensure the person is screened for thyroid disease
29
Q

Briefly describe the monitoring for diabetic eye complications in type 1 diabetes

A
  • On diagnosis→ immediately refer adults with type 1 diabetes to the local eye screening service
  • Depending on the findings, follow structured eye screening by one of the following:
    • Referral to an ophthalmologist
    • Earlier review
    • Routine annual review
30
Q

How often is NHS diabetic eye screening?

A

Annually

31
Q

Briefly describe the monitoring for diabetic kidney disease in type 1 diabetes

A

All adults with type 1 diabetes (with or without detected nephropathy) should receive annual screening for diabetic nephropathy.

  • Ask the person to bring in the first urine sample of the day (‘early morning urine’) once a year
    • Send the urine specimen for estimation of the albumin:creatinine ratio (ACR)
      Check serum creatinine at the same time to calculate estimated glomerular filtration rate (eGFR)
32
Q

What should be offered to men with type 1 diabetes and erectile dysfunction?

A

Offer men the opportunity to discuss erectile dysfunction as part of their regular review.

Offer a phosphodiesterase-5 (PDE-5) inhibitor (sildenafil, vardenafil, or tadalafil) to men with type 1 diabetes with isolated erectile dysfunction.

33
Q

Briefly describe the monitoring for diabetic foot complications in type 1 diabetes

A

People with type 1 diabetes should have their feet checked by a primary healthcare professional at diagnosis and at least once a year thereafter, or sooner if any foot problems arise. They should also be advised to check their own feet on a daily basis.

34
Q

Briefly describe what is assessed in a diabetic foot exam

A

To examine the feet of a person with diabetes, remove their shoes, socks, bandages, and dressings (as appropriate) and examine both feet for evidence of the following risk factors:

  • Neuropathy
  • Limb ischaemia
  • Ulceration
  • Callus formation
  • Infection and/or inflammation
  • Deformity
  • Gangrene
  • Charcot arthropathy

Y3 GP: Diabetes (6 decks)

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