Type 1 Diabetes Mellitus Flashcards
define type 1 diabetes mellitus?
metabolic hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production
what are the common features of a T1DM pt?
o Ketosis o Rapid weight loss o Age of onset below 50 o BMI below 25 o Family history of autoimmune disease
what is the pathophysiology of T1DM?
metabolic hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production
what is the epidemiology of T1DM?
- 0.25% prevalence in the UK
* Often presents juvenile (<30)
what are the symptoms of T1DM?
- Polyuria/nocturia
- Polydipsia
- Tiredness
- Rapid weight loss
- Low BMI below 25
- Family history of autoimmune disease
- DKA
what are associated autoimmune conditions?
o Vitiligo
o Addison’s disease
o Autoimmune thyroid disease
what are the signs of complications of T1DM?
o Fundoscopy - check for diabetic retinopathy
o Examine feet for evidence of neuropathy (monofilament test, pulses)
o Monitor BP
what is the first line investigations for T1DM?
• 1. Urine
o Glycosuria, ketonuria, MSU
• 2. Blood Glucose o fasting blood glucose > 7 mmol/L o random blood glucose > 11.1 mmol/L o HbA1c (not that useful) o Glucose tolerance test
what is the gold standard investigation for T1DM?
• Antibodies =
o Antibodies to glutamic acid decarboxylase (anti- GAD)
o Islet cell antibodies (ICA)
o Insulin autoantibodies (IAA)
o Insulinoma-associated 2 autoantibodies (IA-2A)
• C-Peptide levels - high
what other investigations might be performed in response to T1DM?
- FBC - MCV, reticulocytes
- U&Es - monitor for nephropathy and hyperkalaemia
- Lipid profile
- Urine albumin creatinine ratio - used to detect microalbuminuria
how can blood glucose be controlled for T1DM?
- Short-acting insulin (basal bolus):
- Lispro
- Aspartate
- Glulisine
- Long-acting insulin (twice daily):
- Detemir
- Isophane
- Glargine
what should blood glucose in T1DM patients be monitored?
• Regular capillary blood glucose tests 4 times a day
Targets are the following:
o 5-7 mmol/l on waking
o 4-7 mmol/l before meals at other times of the day
• HbA1c every 3-6 months
o Target of 48mmol/mol (6.5%)
how should an unconsciousness hypo be treated?
glucagon IM
how should a conscious hypo be treated?
50 g oral glucose + starchy snack
complications of T1DM?
• Diabetic ketoacidosis • Microvascular complications: o Retinopathy o Nephropathy o Neuropathy • Macrovascular complications: o Peripheral vascular disease o Ischaemic heart disease o Stroke/TIA
