Type 1 Diabetes Mellitus Flashcards
What is type 1 diabetes mellitus?
Autoimmune disorder caused by t-cell mediated destruction of pancreatic beta cells, leading to insulin deficiency and hyperglycaemia.
What are the possible causes of type 1 diabetes in children?
- Unknown - genetic and environmental
- Hygiene hypothesis?
- Enterovirus?
- Low vitamin D?
- Early cow’s milk?
- High GI food - raised insulin demand?
What is the pathophysiology of type 1 diabetes?
- Threshold for renal glucose reabsorption is exceeded - glycosuria - osmotic diuresis - polyuria - polydipsia.
- Inability to use glucose - lethargy
- Weight loss occurs due to lipolysis
What is this a presentation of?
Several weeks of polyuria, lethargy, polydipsia, weight loss, poor growth, ketosis.
Type 1 diabetes - can present with DKA (medical emergency)
How is type 1 diabetes diagnosed?
- Symptoms of hyperglycaemia and one of either: random glucose >11.1 or fasting >7.
- Or raised either on two separate occasions without symptoms.
- Autoantibodies support diagnosis - anti-insulin, anti-ZnT8, anti-IA2, anti-GAD65.
What is the standard insulin regime for type 1 diabetes?
- Estimate total daily insulin by weight
- Prepubertal - 0.5-1U/kg/day, pubertal - 1.5
- Insulin should be split as half short acting and half long acting.
- Injection technique
What are the lifestyle changes needed in type 1 diabetes?
- Insulin dosing, carbohydrate counting.
- BG monitoring before meals and bed, keep diary.
- Educate symptoms of hypoglycaemia.
- Sick day rules and school plan.
What are the reviews and screening needed after a diagnosis of type 1 diabetes?
- Frequent hospital reviews by MDT - HbA1c
- Annual review - BP, urine ACR, retinal screening, check feet.
- Screen for thyroid disease and coeliac disease.
What is the prognosis of type 1 diabetes?
Life expectancy reduced by 10-years due to macrovascular complications, microvascular complications are a big cause of morbidity.
