Type 1 Diabetes Mellitus

Question 1

What are the 6 classifications of diabetes. (WHO)

Answer 1

> Type 1 diabetes
Type 2 diabetes
Hybrid
Other
Unclassified
During pregnancy

Question 2

When autoimmune diabetes leads to insulin deficiency that presents later in life what is this called?

Answer 2

Latent Autoimmune Diabetes in Adults ( LADA)

Question 3

What is monogenic diabetes?

Answer 3

Diabetes inherited from a parents mutated gene.

Question 4

Give a brief overview of the immunology of diabetes.

Answer 4

> the primary step is the presentation of auto-antigen to auto reactive CD4+ T lymphocytes
CD4+ cells activate CD8+ T lymphocytes
CD8+ cells travel to islets and lyse beta-cells expressing the auto antigen
this all gets exacerbated by the release of pro-inflammatory cytokines
this is all underpinned by defects in T-reg cells failing to suppress autoimmunity

Question 5

What is c peptide?

Answer 5

C-peptide is a short chain of amino acids that is produced when the hormone insulin is made in the pancreas. It is released into the bloodstream at the same time as insulin.

Question 6

What gene mediates genetic susceptibility to T1DM?

Answer 6

By HLA are of genes

Question 7

What are the symptoms of T1DM?

Answer 7

-Polyuria
-Nocturia
-Excessive thirst (polydipsia)
-Weight loss
-Recurrent infections
-Weight loss
-Blurring vision

Question 8

What is T1DM diagnosis based on?

Answer 8

Ketones and sometimes c peptides.

Question 9

What does a lack of insulin cause in the body?

Answer 9

-Proteinolysis of muscles
-Increase hepatic glucose output from the liver
-Lipolysis of fat cells into triglycerides and NEFA

Question 10

What happens to NEFA’s in the liver?

Answer 10

Undergo oxidation to produce ketone bodies

Question 11

Why is insulin never 0?

Answer 11

You’ll start forming ketones, breaking down fat and muscle.

Question 12

What are the 2 types of transplantation for T1DM treatment?

Answer 12

Islet cell transplant- isolate islets from pancreas of deceased donor.
Transplant into hepatic portal vein.

Simultaneous pancreas and kidney transplants

Question 13

How do we monitor glucose levels?

Answer 13

-Capillary (finger prick) blood glucose monitoring.

-Continuous glucose monitoring (restricted availability, NICE guidelines).

Question 14

What does glycated haemoglobin (HbA1c) show?

Answer 14

-Reflects the last 3 months (RBC Lifespan) of glycaemia.

There is a linear relationship between how much glucose we have and how high HbA1c is.

Question 15

How do we diagnose diabetic ketoacidiosis?

Answer 15

NEED ALL 3
-pH < 7.3
-HCO3-<15mmol/L
-Glucose >11mmol/L

Question 16

Is HbA1c useful at identifying hypoglycaemia?

Answer 16

No, looks at the last 3 months together.