Type 1 DM Flashcards
What is the pathophysiology of T1DM?
insulin deficiency from autoimmune destruction of insulin secreting pancreatic beta cells
What is the pathophysiology of T2DM/
↓insulin secretion ± ↑insulin resistance
What is T1DM associated w?
HLA DR3/DR4
What features point to a diagnosis of T1DM in adults?
- Hyperglycaemia - random plasma glucose >11mmol/L
- One or more of the following:
- ketosis
- Rapid weight loss
- age of onset <50yrs
- BMI <25
- PMHx or FHx of autoimmune disease
What features point to a diagnosis of T1DM in children/young people?
- Hyperglycaemia - rapid plasma glucose >11mmol/L
- Polyuria
- Polydipsia
- Weight loss
- Excessive tiredness
When would you suspect T2DM rather than type 1 in children/young people?
T2DM:
- strong FHx of T2DM
- obesity
- black/asian family origin
- No insulin requirement
- Evidence of insulin resistance
What tests would u do to diagnose DM?
- Random plasma glucose ≥11 mmol/L
- Fasting plasma glucose - no caloric intake for at least 8hrs ≥6.9 mmol/L
- Plasma/urine ketone - medium or high
- HbA1c - ≥48 mmol/mol
What is C-peptide?
byproduct formed when pro-insulin is processed to insulin so reflects insulin production
not measured routinely
What level of fasting C-peptide indicates T1DM?
low or undetectable
indicates absence of insulin secretion from pancreatic beta cells
What is the target HbA1c in T1DM?
48 or lower
when should blood glucose be measured in children and young people w T1DM?
At least 5 a day
including before each meal and before bed
What fasting plasma glucose should children/young people w T1DM aim for on waking?
4-7mmol/L
What pre-prandial plasma glucose should children/young people w T1DM aim for
4-7mmol/L
What post-prandial plasma glucose should children/young people w T1DM aim for?
5-9mmol/L
What level plasma glucose should young people of driving age aim for in T1DM?
at least 5mmol/L
How often should HbA1c be measured in T1DM?
Every 3-6mnths
When should blood glucose be monitored more frequently in T1DM?
Increase in hypoglycaemic episodes Periods of illness Before during or after sport Planning and during pregnancy Breastfeeding
What 2 types of insulin should those with T1DM be offered?
- Background (long acting ) insulin injected twice a day
2. Quick acting (rapid acting) injected before each meal, deals w rise in BM from eating
What insulin regimen should children + young people with T1DM be offered first?
MULTIPLE DAILY INJECTION BASAL-BOLUS INSULIN REGIMENS:
Injection of short/rapid acting insulin analogue before meals
+
1 or more daily injections of intermediate/long acting insulin analogue
I.e. rapid before meals + long acting background
What are the other 2 basic types of insulin regimen?
- Continuous subcut insulin infusion
2. One, two or three insulin injections per day - short/rapid + intermediate-acting insulin
What insulin regimen should be offered to adults w T1DM?
multiple daily injection basal-bolus
what drug can be added if insulin doesn’t control BM enough in T1DM?
Dapagliflozin w a BMI of ≥27
How is insulin administered?
subcut
rotating injection sites to prevent lipodystrophy
