Type 1 Diabetes Mellitus

Question 1

What is ideal blood glucose concentration?

Answer 1

4.4-6.1mmol/l

Question 2

Where is insulin produced?

Answer 2

B-cells of the Islets of Langerhans in the pancreas

Question 3

Where is glucagon produced?

Answer 3

a-cells of the Islets of Langerhans in the pancreas

Question 4

What is glycogenolysis?

Answer 4

Breakdown of glycogen into glucose, stimulated by glucagon

Question 5

What is gluconeogenesis?

Answer 5

Production of glucose from proteins and fats, stimulated by glycogen

Question 6

What is ketogenesis?

Answer 6

Production of ketones from fatty acids

Question 7

How do you measure ketones?

Answer 7

Urine dipstick
Ketone metre

Question 8

What happens in type 1 diabetes mellitus?

Answer 8

Pancreas stops producing insulin as B-cells of the Islets of Langerhans are damaged.
This leads to hyperglycaemia.

Question 9

Potential triggers of T1DM?

Answer 9

Coxsackie Virus B
Enterovirus

Question 10

What normally buffers ketone acids?

Answer 10

Bicarbonate produced by the kidneys.

Question 11

How does T1DM lead to dehydration?

Answer 11

Due to osmotic diuresis

Question 12

Why is there potassium imbalance in T1DM?

Answer 12

Insulin normally drives potassium into cells thus in T1DM total body potassium is low as there is no insulin to do this.
Serum potassium may still be normal/high!!!

Question 13

What can potassium imbalance lead to in T1DM?

Answer 13

Hypokalaemia which can lead to arrhythmias

Question 14

Diagnosis of diabetic ketoacidosis?

Answer 14

Hyperglycaemia >11mmol/l
Ketosis >3mmol/l
Metabolic acidosis (low bicarbonate) pH<7.3
K+ imbalance
Dehydration

Question 15

Features of DKA?

Answer 15

Polyuria
Polydipsia
Nausea and vomiting
Acetone breath
Dehydration
Hypotension
Altered consciousness
Trigger? Sepsis?

Question 16

Initial management of DKA?

Answer 16

Venous gas
U&Es
Lab glucose
Urine/blood ketones

Question 17

Treatment of DKA?

Answer 17

Fluid resuscitation: 1l NaCl 0.9% over 1 hour.
Add insulin infusion: IV 6 units/hr.
Then 1l NaCl 0.9% on hour 2 +KCl for potassium imbalance.

Question 18

What do we use for the long-term management of T1DM?

Answer 18

Background long-acting insulin and short-acting insulin

Question 19

What is important to remind patients who are injecting insulin?

Answer 19

To rotate injection sites to avoid lipodystrophy

Question 20

What do we use to monitor blood glucose in T1DM?

Answer 20

HbA1c every 3-6 months
Capillary blood glucose
Flash glucose monitoring