Type 1, Clinical Features, Pathophysiology, Treatment

Question 1

what used to be the biggest killer of diabetic and what is now

Answer 1

used to be coma

now thanks to insulin is cardiac/renal complications

Question 2

what is the definition of type 1 diabetes

Answer 2

A state of absolute insulin deficiency probably caused by an environmental trigger in a genetically susceptible individual mediated by an auto immune response attacking the pancreatic B cells

Question 3

how do you diagnose diabetes

Answer 3

fasting glucose >7
random >11.1
and symptoms OR repeat

Question 4

how to diagnose type 1 or type 2 diabetes

Answer 4

Type 1 - history and presentation eg. DKA alone

If in doubt, GAD/IA2 antibodies (and C peptide) may help

Question 5

what happens to a normal pancreatic islet in type 1 diabetes

Answer 5

it gets attacked by lymphocytes

Question 6

what happens to a normal pancreatic islet in type 2 diabetes

Answer 6

as the B cells start to go into decline amyloid deposits start to form in the pancreas

Question 7

what is the association between HLA and risk of type 1 diabetes

Answer 7

HLA genes represent 50% of the familial risk of T1DM

95% of those with T1DM under 30 have one or both of the HLA genotypes

Only 10% of people with susceptible HLA develop DM

Question 8

what are some environmental triggers for the onset of T1DM

Answer 8

viral infection
maternal factors
weight gain

also a seasonal variation in date of diagnosis (more in winter)

Question 9

What are the islet cell auto-antibodies

Answer 9

IA-2
IAA
GAD65
ZnT8

Question 10

what are the autoantibodies seen in type 1 diabetes

Answer 10

GAD65Ab (targets glutamic acid decarboxylase)
IA-2AB (targets islet antigen 2)
IAA (targets insulin)
ZnT8Ab (targets ZnT8 transporter)

Question 11

what are some foetal risk factors for type 1 diabetes

Answer 11

infection
age
ABO mismatch
Birth order

Question 12

what are the histopathological disease markers of T1DM

Answer 12

raised glucose 
ketones 
decreased insulin 
decreased B cell mass 
decreased c peptide

Question 13

what is the classical triad of presenting features of T1DM

Answer 13

Polyuria
-also enuresis in children
Polydipsia (thirst)
Weight loss

Question 14

What are the clinical features other than the classic triad that present in T1DM

Answer 14

fatigue and somnolence 
blurred vision 
Candidal infection 
pruritus vulvae 
balanitis 
in established ketone-acidosiss

Question 15

things to ask/think about in a newly presenting patient

Answer 15

has diabetes been confirm 
what type (antibody testing) 
is hospitalisation required 
-DKA 
-significant ketonaemia 
-vomiting 
are they at school/college/uni 
if not what's their employment 
do they drive

Question 16

Management of a newly diagnosed T1DM patient

Answer 16

blood glucose and ketone monitoring 
Insulin usually basal (once daily) and bolus (with meals)
carbohydrate estimation 
regular dietitian contact 
appropriate medical clinic review

Question 17

what is the ideal HbA1c range for T1DM

Answer 17

48-58 mmol/mol

Question 18

what is checked in the annual review assessment

Answer 18

weight 
bp 
bloods - HbA1c, Renal function, Lipids 
retinal screening 
foot risk assessment

Question 19

what % of patients with cystic fibrosis will go on to develop T1DM

Answer 19

20%

Question 20

what intensified insulin therapy should be given for type 1 adults

Answer 20

human or rapid acting insulin analogues

Question 21

when are basal insulin analogues recommended

Answer 21

in patients with type 1 who are experiencing severe or nocturnal hypos

Question 22

what insulin regimen is given to children

Answer 22

insulin analogs (rapid or basal)
regular human insulin
NPH preparations (intermediate)
combination of all 3

Question 23

what are the overlap diabetes between types 1 and 2

Answer 23

MODY
LADA
Mitochondrial gene mutations
Amylin gene mutations

Question 24

how is insulin secreted normally

Answer 24

Biphasic secretion in response to a meal

• rapid phase of preformed insulin lasts 5-10 mins
• slow phase over 1-2 hours

Question 25

where is insulin secreted into naturally

Answer 25

portal vein

Question 26

what are children diagnosed under the age of 6 months most likely to have

Answer 26

monogenic diabetes

Question 27

what is LADA

Answer 27

later onset diabetes of adulthood

elevated pancreatic autoantibodies in a patient with recently diagnosed diabetes who does not require insulin

(also known as slow progressive type 1 or type 1.5)

Question 28

features of LADA

Answer 28

occurs in young adults 25-40 
males 
non-obese
auto-antibody positive 
associated autoimmune conditions 
non-insulin requiring at diagnosis 
sub-optimal control on oral agents

Question 29

what is DIDMOAD or Wolfram syndrome

Answer 29

diabetes insipidus
diabetes mellitus 
optic atrophy 
deafness 
neurological anomalies

Question 30

wha is barred bide syndrome

Answer 30

often seen in very obese 
polydactyly (extra fingers/toes) 
hypogonadal 
visual impairment 
mental retardation
diabetes 
consanguineous parents (inbred)

Question 31

common associated autoimmune conditions with T1DM

Answer 31

thyroid disease 
coeliac disease 
pernicious anaemia 
Addisons disease 
IgA deficiency

Question 32

what diseases are involved in type 1 polyglandular endocrinopathy

Answer 32

Addisons disease 
vitiligo 
primary hyponadism 
primary hypothyroidism 
coeliac disease