Introduction to Case

Question 1

What are the complications of type 1 diabetes

Answer 1

• leading cause of heart disease
• most common cause of blindness, renal failure, ulceration and amputation

Question 2

where does type 1 diabetes occur

Answer 2

in the pancreas
- pancreas detects changes in blood glucose

Question 3

name the cells within the pancreas

Answer 3

1. alpha-cells
2. insulin producing B cells

Question 4

what are a-cells in the pancreas

Answer 4

red cells surrounding islets which mobilise glucose

Question 5

what are insulin producing b cells

Answer 5

respond to changes in blood glucose and secrete insulin

Question 5

what cells are damaged in type 1 diabetes

Answer 5

insulin producing B cells

Question 6

what is meant by hypoglycaemia

Answer 6

low blood glucose

Question 7

what is meant by hyperglycaemia

Answer 7

high blood glucose

Question 8

describe the islets found in type 1 diabetes

Answer 8

no insulin producing cells
- B cells failure
- leaving patients dependent on insulin injections

Question 9

describe the islets found in type 2 diabetes

Answer 9

slower but eventual B cell failure

Question 10

what is type 1 diabetes known as

Answer 10

insulin dependent diabetes mellitus

Question 11

describe the onset of type 1 diabetes

Answer 11

early/juvenile onset
5-10% of diabetes is type 1

Question 12

how does type 1 diabetes occur

Answer 12

autoimmune destruction of B cells

Question 13

what can be used to test blood glucose

Answer 13

finger prick monitoring testing 10-15 times a day
- to keep blood glucose under control

Question 14

what are insulin pumps

Answer 14

automated system to deliver insulin
- cannula with a small needle given in the abdomen

Question 15

outline the symptoms of type 1 diabetes

Answer 15

1. unexplained weight loss- as glucose is not being used for energy
2. polydipsia (increased thirst)- as body is trying to get rid of excess blood glucose
3. polyuria (frequent urination)
4. polyphagia (increased hunger)- without insulin, unaware that you have high glucose level
5. blurred vision (one or both eyes)- due to changes in osmotic pressure in the eye
6. dizziness, due to dehydration/low blood pressure
7. fatigue- can’t process glucose
8. genital itching, bacterial infections or yeast infections
9. slow wound healing/infections- due to nerve damage

Question 16

name the diagnostic tests used for type 1 diabetes

Answer 16

1. a random plasma glucose test
2. fasting plasma glucose tolerance test
3. oral glucose tolerance tests
4. HbA1c

Question 17

how is a random plasma glucose test used as a diagnostic test for type 1 diabetes

Answer 17

1. blood is drawn and tested for the level of glucose in the blood
2. random plasma glucose concentration of >11.1mmol/l

Question 18

how is a fasting plasma glucose tolerance test used as a diagnostic test for type 1 diabetes

Answer 18

1. no food/drink 8-12 hours prior to test
2. blood is drawn and tested for level of glucose in blood
3. fasting plasma glucose concentration of >7mmol/l

Question 19

how are oral glucose tolerance tests used as a diagnostic test for type 1 diabetes

Answer 19

1. no food/drink 8-12 hours prior to test
2. drink 75g of glucose (lucozade)
3. blood is tested 2 hours later
4. plasma glucose concentration of >11.1mmol/l, 2 hours after test

Question 20

what is HbA1c used for

Answer 20

used as a diagnostic test and management tool

Question 21

what is HbA1c

Answer 21

glycosylated haemoglobin

Question 22

what is HbA1c level like in patients with type 1 diabetes

Answer 22

high HbA1C

Question 23

how can HbA1C be used as a management tool

Answer 23

• tells us how controlled blood glucose is over last 3 months
• looking to see if HbA1C decreases after starting treatment regime

Question 24

what is the target range of HbA1C

Answer 24

6% or 42mmol/mol

Question 25

describe the self care problems in type 1 diabetes

Answer 25

1. optimal glycaemic control is very hard to achieve 2. complex to manage- all patients offered a structured education programme (SEP) 3. adolescents become increasingly independent as part of normal development 4. managing transition from paediatric care to adult care

Question 26

what is meant by transition in type 1 diabetes

Answer 26

refers to the movement of an adolescent from paediatric to adult diabetes care services

Question 27

what is the difference between paediatric and adult services

Answer 27

paediatric care is holistic and family centred, adult services are more disease focussed

Question 28

why might it be difficult to transition from paediatric to adult services

Answer 28

- parents can feel left out or that they are losing control - young person can feel anonymous and not important to new care team

Question 29

how does the NHS ensure good transitional care

Answer 29

paediatric NHS diabetes services are commissioned under a Best practice tariff for every young patient up to age 19

Question 30

what is the best practice tariff

Answer 30

- sets out high standards of care and providers will be paid only when they prove their service meets required standards - includes requirements for a transitional care policy, where young people will be gradually handed over to adult services in an individualised, collaborative way

Question 31

what are some aspects of managing good transition

Answer 31

1. care team needs to be flexible 2. provide individualised care, only hand over when the young person has self care autonomy 3. involve family members/carers 4. both paediatric and adult teams should overlap 5. work through as a process, transition is not a one off event