Type 1 Diabetes Mellitus

Question 1

Define:

Answer 1

Metabolic hyperglycaemic state caused by an insufficiency of insulin.

It is due to autoimmune destruction of pancreatic islet cells.

Question 2

Aetiology/risk factors:

Answer 2

This is an autoimmune condition.

Genetic predisposition with an environmental trigger

Associated with HLA-DR3/4 >90%

LADA - slower progression

Question 3

Antibodies associated with T1DM:

Answer 3

o Glutamic acid decarboxylase (GAD)
o Insulin
o Insulinoma-associated protein 2
o Cation efflux zinc transporter

Question 4

Epidemiology:

Answer 4

0.25% of the UK prevalence

Question 5

Symptoms:

Answer 5

Juvenile onset (<30 years)

Weight loss

tiredness

Polyuria

polydipsia

Question 6

Signs of complications:

Answer 6

Fundoscopy - retinopathy

Feet monofilament - neuropathy

DKA - Kussmaul breathing, nausea, vomiting (will not occur in type 2 and there is insulin to suppress the formation of ketones)

Question 7

Signs of other auto-immune conditions:

Answer 7

Vitiligo

Thyroid diseases

Addison’s.

Question 8

Investigations:

Answer 8

Urinanalysis –> random glucose –> fasting glucose –> OGTT –> HbA1C

FBC - MCV and reticulocytes

U + E’s - look at K+ and nephropathy

Urine albumin:creatinine - microalbinumina

Urine - glycosuria and ketouria

Lipid profile

Question 9

Management:

Answer 9

Education - how and when to adjust the dose

Short acting insulin (3 times a day);
 Lispro
 Aspart
 Glulisine

Long acting (once a day);
 Isophane
 Glargine
 Detemir

Monitor HbA1c every 3-6 months and capillary glucose regularly.

Insulin pumps and disposable pens

Question 10

How to manage hypoglycaemia:

Answer 10

• If reduced consciousness: 50 ml of 50% glucose IV OR 1 mg glucagon IM

If consciousness and cooperative: 50 g oral glucose + starchy snack

Question 11

Complications:

Answer 11

DKA- due to infection or improper control of diabetes

Hypoglycaemia

Microvascular:

• retinopathy
• nephropathy
• neuropathy

Macrovascular:

• PVD
• IHD
• Stroke/TIA

Increased risk of infections

Weight gain due to the treatment

Question 12

What are symptoms of hypoglycaemia:

Answer 12

• Personality changes
• Fits
• Confusion
• Coma
• Pallor
• Sweating
• Tremor
• Tachycardia
• Palpitations
• Dizziness
• Hunger
• Focal neurological symptoms

Question 13

Prognosis

Answer 13

• Depends on early diagnosis, good glycaemic control and compliance with treatment and screening
• Vascular disease and renal failure are the main causes of increased morbidity and mortality