Type 1 Diabtets

Question 1

What is Type 1 DM?

Answer 1

• Type 1 DM is a disease where the pancreas stops being able to produce insulin
• Insulin works by getting the muscle and liver to take up glucose
• When the pancreas is not producing insulin the cells of the body cannot take glucose from the blood
• This causes hyperglycaemia

Question 2

What is the ideal range for blood glucose?

Answer 2

• 4.4mmol/L to 6.1mmol/L

Question 3

What is the Physiology of Type 1 Diabetes?

Answer 3

• Insulin is a hormone produced by the pancreas that reduces blood sugar levels
• Insulin is produced by the beta cells in the Islets of Langerhans in the pancreas
• It is an anabolic hormone
• It is always present in small amounts but increase when blood sugar levels rise

1st: causes cells to absorb glucose from the blood and use it as fuel
2nd: It causes muscle and liver cells to absorb glucose from the blood and store it as glycogen
- Insulin is essential in letting cells take glucose out of the blood and use it as fuel
- without insulin, cells cannot take up and use glucose

• Glucagon is procured by the alpha cells in the Islets of Langerhans in the pancreas.
• It is released in response to low blood sugar levels and stress
• It tells the liver to break down stored glycogen into glucose known as glycogenolysis
• It also tells the liver to convert proteins and fats into glucose known as gluconeogenesis
• Ketogenesis occurs when there is insufficient supply of glucose and glycogens stores are exhausted such as in prolonged fasting
• The liver takes fatty acids and converts them to ketones
• Ketones are water soluble fatty acids that can be used as fuel
• They can cross the blood brain barrier and can be used by the brain
• producing ketones is normal and not harmful in healthy patients when under fasting conditions or on very low carbohydrate, high fat diet
• people in ketosis have a characteristic acetone smell to their breath

Question 4

How do paediatric patients with type 1 diabetes present?

Answer 4

Typically with hyperglycaemia:
- Polyuria
- Polydipsia
- Weight loss

• Secondary enuresis (bedwetting in a previously dry child) and secondary infections
• symptoms are usually present from 1-6 weeks prior to developing DKA

Question 5

When a new diagnosis of type 1 diabetes is trying to be established what bloods should be taken to exclude other associated pathology and get a baseline idea of the child’s overall health?

Answer 5

• Baseline bloods: FBC, U&E, laboratory glucose
• Blood cultures
• HbA1c
• TFTs and TPO to test for autoimmune thyroid disease
• anti-TTG (tissue transglutaminase for associated coeliac disease)
• Insulin antibodies, anti-GAD antibodies and Islet cell antibodies to test for antibodies associated with destruction of the pancreas and the development of type 1 diabetes

Question 6

What is the long term management for type 1 diabetes?

Answer 6

• Subcutaneous Insulin Regimes
• Monitoring dietary carbohydrate intake
• Monitoring blood sugar levels on waking, at each meal and before bed
• Monitoring for and managing complications both short and long term

Question 7

What do you need to know about prescribing Insulin?

Answer 7

• Insulin is usually prescribed as a combination of background, long acting insulin given once a day and a short acting insulin injected 30 minutes before the intake of carbohydrates
• Alternatively insulin can be given by an insulin pump
• Injecting into the same spot repeatedly can cause a condition called lipodystrophy, where th subcutaneous fat hardens and prevents normal bsor