Diabetes- type 1

Question 1

Presentation

Answer 1

Signs and symptoms in new diangosis are typically in DKA

Question 2

Features of DKA

Answer 2

Abdo pain

Polyuria/ polydipsia/ dehydration

Kussmaul respiration

Acetone-smelling breath

Hyperglycaemia

Potassium imbalance

Question 3

Investigations for diabetes

Answer 3

Urine dip for glucose and ketones

Fasting glucoe and random glucose

HbA1c no useful as may not reflect recent rapid rise in serum glucose

C-peptide levels low in T1DM

Question 4

Diagnosis

Answer 4

Symptomatic

Fasting glucose >7.0mmol/L

Random glucose>11.0mmol/L

Question 5

HbA1c monitoring

Answer 5

Every 3-6 months

Target <48mmol

Question 6

Self-monitoring of blood glucose

Answer 6

Recommend testing at least 4 times a day (before each meal and before bed)

More frequent monitoring if frequent hypoglycaemia, period of illness, before/during/after sport, when planning pregnancy, during pregnancy, breastfeeding

Question 7

Blood glucose targets

Answer 7

5-7mmol/L on waking

4-7mmol/L before meals and other times of the day

Question 8

Type of insulin

Answer 8

Multiple injection basal-bolus insulin regimens for all adults

Twice dailt insulin detemir is regime of choice

Rapid acting insulin analogues before meals

Question 9

Short term complications

Answer 9

Hypoglycaemia (tremor, sweating, irritable, dizzy, pallor, LOC, coma, death)

Hyperglycaemia (lead to DKA)

Question 10

Macrovascular complications

Answer 10

Coronary artery disease is major cause of death

Peripheral ischaemia causing poor healing, ulcers, diabetic foot

Stroke

HTN

Question 11

Microvascular complications

Answer 11

Peripheral neuropathy

Retinopathy

Kidney disease (glomerulosclerosis)

Question 12

Infection related complications

Answer 12

UTI

Pneumonia

Skin and soft tissue infections

Fungal infections (candidiasis)