Type 1 Diabetes Mellitus Flashcards

1
Q

define type 1 diabetes mellitus?

A

metabolic hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production

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2
Q

what are the common features of a T1DM pt?

A
o	Ketosis 
o	Rapid weight loss 
o	Age of onset below 50 
o	BMI below 25 
o	Family history of autoimmune disease
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3
Q

what is the pathophysiology of T1DM?

A

metabolic hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production

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4
Q

what is the epidemiology of T1DM?

A
  • 0.25% prevalence in the UK

* Often presents juvenile (<30)

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5
Q

what are the symptoms of T1DM?

A
  • Polyuria/nocturia
  • Polydipsia
  • Tiredness
  • Rapid weight loss
  • Low BMI below 25
  • Family history of autoimmune disease
  • DKA
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6
Q

what are associated autoimmune conditions?

A

o Vitiligo
o Addison’s disease
o Autoimmune thyroid disease

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7
Q

what are the signs of complications of T1DM?

A

o Fundoscopy - check for diabetic retinopathy
o Examine feet for evidence of neuropathy (monofilament test, pulses)
o Monitor BP

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8
Q

what is the first line investigations for T1DM?

A

• 1. Urine
o Glycosuria, ketonuria, MSU

•	2. Blood Glucose 
o	fasting blood glucose > 7 mmol/L 
o	random blood glucose > 11.1 mmol/L 
o	HbA1c  (not that useful) 
o	Glucose tolerance test
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9
Q

what is the gold standard investigation for T1DM?

A

• Antibodies =
o Antibodies to glutamic acid decarboxylase (anti- GAD)
o Islet cell antibodies (ICA)
o Insulin autoantibodies (IAA)
o Insulinoma-associated 2 autoantibodies (IA-2A)

• C-Peptide levels - high

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10
Q

what other investigations might be performed in response to T1DM?

A
  • FBC - MCV, reticulocytes
  • U&Es - monitor for nephropathy and hyperkalaemia
  • Lipid profile
  • Urine albumin creatinine ratio - used to detect microalbuminuria
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11
Q

how can blood glucose be controlled for T1DM?

A
  • Short-acting insulin (basal bolus):
  • Lispro
  • Aspartate
  • Glulisine
  • Long-acting insulin (twice daily):
  • Detemir
  • Isophane
  • Glargine
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12
Q

what should blood glucose in T1DM patients be monitored?

A

• Regular capillary blood glucose tests 4 times a day
Targets are the following:
o 5-7 mmol/l on waking
o 4-7 mmol/l before meals at other times of the day

• HbA1c every 3-6 months
o Target of 48mmol/mol (6.5%)

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13
Q

how should an unconsciousness hypo be treated?

A

glucagon IM

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14
Q

how should a conscious hypo be treated?

A

50 g oral glucose + starchy snack

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15
Q

complications of T1DM?

A
•	Diabetic ketoacidosis  
•	Microvascular complications: 
o	Retinopathy 
o	Nephropathy 
o	Neuropathy  
•	Macrovascular complications: 
o	Peripheral vascular disease  
o	Ischaemic heart disease  
o	Stroke/TIA
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16
Q

complications of treatment of T1DM?

A

o Weight gain
o Fat hypertrophy at insulin injection sites
o Hypoglycaemia

17
Q

what is the prognosis of T1DM?

A

• Depends on early diagnosis, good glycaemic control and compliance with treatment and screening