Type 1 Diabetes Mellitus

Question 1

Define type 1 DM

Answer 1

Insulin deficiency from autoimmune destruction of insulin-secreting pancreatic beta cells

Question 2

How does failure of insulin secretion cause pathology?

Answer 2

Leads to continued breakdown of liver glycogen, unrestrained lipolysis and skeletal muscle breakdown, suppression of peripheral glucose uptake

Question 3

What are the key presentations of T1DM?

Answer 3

Weight loss, polyuria, polydipsia

Question 4

What are some signs of T1DM?

Answer 4

High levels of islet antibodies, raised random and fasting plasma glucose

Question 5

What is the best insulin treatment for T1DM?

Answer 5

Basal to cover in between meals and night time, bolus pre-meal to cover meals

Question 6

What should you educate the patient on?

Answer 6

Self-adjusting doses based on exercise, finger prick glucose, calorie intake, carbohydrate counting. Illness increasing insulin requirements. General lifestyle advice

Question 7

What are some complications of T1DM?

Answer 7

Hypoglycaemia, DKA, Vascular disease, Nephropathy, Diabetic retinopathy, Neuropathy

Question 8

What HbA1c target should you aim for?

Answer 8

Lowest not associated with frequent hypoglycaemia. (<58 mmol per mol) In patients with advanced disease, relax targets. (64-69 mmol per mol)