T1DM

Question 1

What is T1DM?

Answer 1

Occurs when the pancreas does not produce insulin

Inability to convert glucose (sugar) into energy

Less sensitive to the effect of insulin (insulin resistance)

Question 2

What are the two forms of T1DM?

Answer 2

Immune mediated: beta cells destroyed by autoimmune process

Idiopathic: cause of beta cell function loss

Question 3

What are the sign and symptoms of T1DM?

Answer 3

Polyuria

Polydipsia

Fatigue

Wound healing

Weight loss

Question 4

What is DKA?

Answer 4

Diabetic ketoacidosis:
Produce ketones to use for energy

Increase the bloods acidity

Loss of body salt & fluids

Immediate medical attention required

Question 5

What are the complications of T1DM?

Answer 5

Heart disease (CVD)

Kidneys- Diabetic Kidney Disease (DKD)

Feet (Diabetic Neuropathy)

Eyes (Diabetic Retinopathy)

Question 6

What are the ways to diagnose T1DM?

Answer 6

Fasting plasma glucose (FPG)

Random plasma glucose (any time of the day)

Oral glucose tolerance test (OGTT)
Fasting: 5.5–6.9
Random: 5.5–11.0 mmol/L

HbA1c
≤7%.

Geno testing

Question 7

What are the symptoms of Hyperglycaemia >15mmol/L ?

Answer 7

Thirst++				
Fatigue++
Blurred vision 
Urination++
Lack of concentration 
Irritable

Question 8

What are the symptoms of Hypoglycaemia <4mmol/L ?

Answer 8

Shaking, trembling or weakness
Sweating
Light headed / headache 
Paleness
Slurred speech 
Unconsciousness 
Confusion

Question 9

When should you monitor your BGL’s?

Answer 9

Before breakfast (fasting)

Before lunch/dinner

Two hours after a meal

Before bed

Before rigorous exercise

When feeling unwell

Question 10

What is the role of a Dietitian when working with a T1DM Patient?

Answer 10

Carbohydrate (CHO) awareness

CHO and GI

CHO distribution

Small, frequent meals

Monitor and change, monitor and change, monitor and change!

Question 11

What is a possible PESS statement for a patient with T1DM?

Answer 11

(1) : Nutrition knowledge deficit related to new Dx T1DM as evidenced by HbA1c 11.8%, Wt loss 30kg (30%) LOW and diet Hx containing high GI foods.
(2) : Mild-Moderate malnutrition related to unintentional weight loss on b/g new Dx T1DM as evidenced by 30kg (30%) LOW and mild-moderate muscle wastage & subcutaneous fat loss, SGA B., HbA1c 11.8%.

Question 12

What is a T1DM Patient Energy, Protein and Fluid Requirements?

Answer 12

EER: (100 - 125kJ/kg/d)
EPR: (0.8 - 1.2g/kg/d)
EFR: (30-35mL/kg/d)

Question 13

What is the Intervention plan for a T1DM Patient?

Answer 13

Change to Diabetic diet & High Protein
Daily testing: fasting, pre BF/L/D & 2hrs post BF/L/D
Referral to Diabetes educator (DE)
NEMO FEEDS: Dietitian to provide education once stable.

Education provided on: 
Understanding 15g Carbohydrate (CHO)
CHO counting  
Low glycemic (GI) diet 
CHO and exercise
Protein prioritisation
Provide hospital CHO ready reckoner