Type 1 Diabetes Mellitus

Question 1

Definition of diabetes

Answer 1

Symptoms and random plasma glucose ≥ 11.1 mmol/l

Fasting plasma glucose ≥ 7.0 mmol/l

HbA1c ≥ 48 mmol/mol

Question 2

What is HbA1c?

Answer 2

Blood test measuring average blood glucose levels over previous 2-3 months. Refers to protein that carries the oxygen. Glucose in blood attaches to haemoglobin to form glycated haemoglobin.

Question 3

What does OGTT stand for?

Answer 3

Oral Glucose Tolerance Test

Question 4

How is an OGTT carried out?

Answer 4

Fasting food and drink (except water) for 8 hours/overnight prior to testing. Blood test to measure fasting blood glucose levels. Then give 75g glucose. Blood samples taken at intervals and levels analysed to see effectiveness of processing glucose over time. Elevated blood glucose may indicate diabetes.

Question 5

Presenting features of diabetes

Answer 5

Thirst
Polyuria
Weight loss
Fatigue (lipid and muscle loss due to unrestrained gluconeogenesis)
Hunger (lack of useable energy source)
Vaginal candidiasis
Chest/skin infections
Blurred vision (altered acuity due to uptake of glucose/water into lens)

Question 6

The severity of type 1 diabetes mellitus symptoms depends on rate of…

Answer 6

B-cell destruction

Question 7

Suggestive features of type 1 diabetes mellitus

Answer 7

Onset in childhood/adolescence
Lean body habitus
Acute onset of osmotic symptoms
Prone to ketoacidosis
High levels of islet autoantibodies

Question 8

Any 2 of what 3 features indicate Type 1 diabetes?

Answer 8

Weight loss
Short history (weeks) of severe symptoms
Moderate or large urinary ketones

Question 9

Having at least 2 of the 3 key signs calls for immediate…

Answer 9

insulin treatment at any age

Question 10

Suggestive features of Type 2 diabetes

Answer 10

Usually presents in over 30s
Onset is gradual
Family History
Almost 100% concordance in identical twins

Question 11

In type 2 diabetes what can help control hyperglycaemia?

Answer 11

Diet
Exercise
Oral medication
Insulin may be required later in disease

Question 12

If in doubt between Type 1 and Type 2 diabetes, what should you do?

Answer 12

Treat with insulin

Question 13

Other than diabetes, what other diseases are linked to autoimmunity antibodies

Answer 13

Hypothyroidism
Addisons’ Disease
Coeliac disease

Question 14

Reduced insulin Type 1 diabetes leads to ___ breakdown and formation of ______ and f___ f____ a____

Answer 14

fat
glycerol
free farry acids

Question 15

Free fatty acids impair g___ uptake

Answer 15

glucose

Question 16

Free fatty acids are transported to the liver and provide energy for g______

Answer 16

gluconeogenesis

Question 17

Free fatty acids are oxidised to form…

Answer 17

ketone bodies (beta hydroxybutyrate, acetoacetate and acetone)

Question 18

Absence of insulin and rising counterregulatory hormones leads to increasing h_______ and rising k____

Answer 18

hyperglycaemia
ketones

Question 19

Glucose and ketones escape in the urine but lead to an o___ d____ and falling circulating blood volume

Answer 19

osmotic diuresis

Question 20

Ketones cause a_____ and v_____

Answer 20

anorexia and vomiting

Question 21

Ketoacidosis creates a vicious circle of increasing d______, h_____ and increasing acidosis eventually leads to circulatory collapse and death

Answer 21

dehydration, hyperglycaemia

Question 22

Definition of Diabetic Ketoacidosis (DKA)

Answer 22

Hyperglycaemia (plasma glucose usually <50 mmol/l)
Raised plasma ketones (urine ketones > 2+)
Metabolic acidosis - plasma bicarbonate < 15 mmol/l

Question 23

Clinical symptoms of DKA

Answer 23

Develop over few days
Polyuria
Polydipsia
Nausea and vomiting
Weight loss
Weakness
Abdominal pain
Drowsiness / confusion

Question 24

Clinical signs of DKA

Answer 24

hyperventilation (Kussmaul breathing - deep, rapid, consistent pace)
Dehydration (average fluid loss 5-6 litres)
Hypotension
Tachycardia

Question 25

Biochemical diagnosis of DKA

Answer 25

Hyperglycaemia

High blood K+ despite total body K+ deficit (due to shift of K+ out of cell with acidosis)

Bicarbonate < 15 mmol/l

Urea and creatinine raised due to pre-renal failure

Urinary ketones dipstix > 2+ ketones

Blood ketones> 3.0

Question 26

Management of DKA

Answer 26

Rehydration (3 litres first 3 hours)

Insulin (Inhibits lipolysis, ketogenesis and acidosis, reduces hepatic glucose production, increase tissue glucose uptake)

Replacement electrolytes (K+)

Treat underlying cause

Follow DKA protocol in hospital

Question 27

Treatment for DKA must be started without d____!

Answer 27

delay

Question 28

Complications of DKA

Answer 28

Cerebral Oedema (deterioration in conscious level, children more at risk due to rehydration in treatment)

Adult Respiratory Distress syndrome (due to rehydration in treatment, drown lungs)

Thromboembolism (venous and arterial, increased blood viscosity)

Aspiration pneumonia

Death

Question 29

Those with nephropathy tend to develop proliferative r______ and severe n____ with major effect on quality of life

Answer 29

retinopathy
neuropathy

Question 30

Treatment of Type 1 diabetes

Answer 30

Insulin treatment: twice daily of short/medium acting insulin, basal bolus

Educate blood glucose lowering effect of exercise

Education about judging carbohydrate intake

Question 31

Inappropriately high levels of insulin confer a high risk of _______

Answer 31

hypoglycaemia

Question 32

Symptoms of hypoglycaemia in type 1 diabetics

Answer 32

Sweating, impaired vision, weakness fatigue, headache, irritability, hunger, fast heartbeat, shaking

Question 33

Acute deprivation of glucose within the brain leads to cerebral dysfunction which can look like…

Answer 33

loss of concentration, confusion, coma

Question 34

What 2 hormones are released as physiological defences to hypoglycaemia

Answer 34

Glucagon and adrenaline

Question 35

What does DAFNE stand for?

Answer 35

Dose Adjusting For Normal Eating

Question 36

For Type 1 Diabetics, setting higher glucose targets will reduce the risk of h_______ but increase the risk of diabetic complications

Answer 36

hypoglycaemia

Question 37

For Type 1 Diabetes, setting lower glucose targets will reduce the risk of complications but increase the risk of h_______

Answer 37

hypoglycaemia