Type 1 Diabetes Mellitus Flashcards
Investigations
urine dip - glucose and ketones
fasting glucose >[…].0mmol/L and random glucose >[…].0mmol/L (or after OGTT)
C-peptide levels are typically […] in patients with T1DM
diabetes-specific autoantibodies are useful to distinguish between type 1 and type 2 diabetes
Investigations
urine dip - glucose and ketones
fasting glucose and random glucose (see below for diagnostic thresholds)
HbA1c is not as useful for patients with a possible or suspected diagnosis of T1DM as it may not accurately reflect a recent rapid rise in serum glucose
C-peptide levels are typically low in patients with T1DM
diabetes-specific autoantibodies are useful to distinguish between type 1 and type 2 diabetes
HbA1c in T1DM
HbA1c is not as useful for patients with a possible or suspected diagnosis of T1DM as it may not accurately reflect a recent rapid rise in serum glucose
Role of C-peptide
[…] when atypical features e.g. age […] years or above, BMI of […] kg/m² or above, […] evolution of hyperglycaemia or […] prodrome
Role of C-peptide
Differentiate when atypical features e.g. age 50 years or above, BMI of 25 kg/m² or above, slow evolution of hyperglycaemia or long prodrome)
Autoantibodies in T1DM
1. […] acid […] (anti-[…])
2. […] […] antibodies ([…], against cytoplasmic proteins in the beta cell)
3. Insulin autoantibodies (IAA)
4. Insulinoma-associated-2 autoantibodies (IA-2A)
Autoantibodies in T1DM
1. glutamic acid decarboxylase (anti-GAD)
2. Islet cell antibodies (ICA, against cytoplasmic proteins in the beta cell)
3. Insulin autoantibodies (IAA)
4. Insulinoma-associated-2 autoantibodies (IA-2A)
HbA1c monitoring
HbA1c should be monitored every […]-6 months
adults should have a target of HbA1c level of […] mmol/mol (6.5%) or lower.
HbA1c monitoring
HbA1c should be monitored every 3-6 months
adults should have a target of HbA1c level of 48 mmol/mol (6.5%) or lower.
Self-monitoring of blood glucose
4 times a day, including before each meal and before bed
more frequent monitoring is recommended if frequency of hypoglycaemic episodes increases; during periods of illness; before, during and after sport; when planning pregnancy, during pregnancy and while breastfeeding
Self-monitoring of blood glucose
4 times a day, including before each meal and before bed
more frequent monitoring is recommended if frequency of hypoglycaemic episodes increases; during periods of illness; before, during and after sport; when planning pregnancy, during pregnancy and while breastfeeding
Blood glucose targets
5-[…] mmol/l on waking and
4-[…] mmol/l before meals at other times of the day
Blood glucose targets
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
Mx
Basal bolus insulin - e.g. basal […]+ short-acting […] before meals
detemir, Novorapid
Associated illnesses:
[…] disease (most associated; screening recommended)
[…] disease
Associated illnesses:
Thyroid disease (most associated; screening recommended)
Coeliac disease
Chronic exposure to hyperglycaemia causes damage to the […] cells of blood vessels –> leaky, malfunctioning vessels that are unable to regenerate.
High levels of sugar in the blood also causes suppression of the […] […], and provides an optimal environment for infectious organisms to thrive.
Macrovascular Complications
[…] […] […] is a major cause of death in diabetics
[…] […] causes poor healing, ulcers and “diabetic […]”
[…]
[…]
Microvascular Complications
Peripheral […]
Diabetic […]
Kidney disease, particularly […]
Chronic exposure to hyperglycaemia causes damage to the endothelial cells of blood vessels. This leads to leaky, malfunctioning vessels that are unable to regenerate. High levels of sugar in the blood also causes suppression of the immune system, and provides an optimal environment for infectious organisms to thrive.
Macrovascular Complications
Coronary artery disease is a major cause of death in diabetics
Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”
Stroke
Hypertension
Microvascular Complications
Peripheral neuropathy
Retinopathy
Kidney disease, particularly glomerulosclerosis
Advice
Rotate […] site to avoid […]
Advice
Rotate injection site to avoid lypodystrophy
