T1DM

Question 1

What happenes

Answer 1

Autoimmune destruction of pancreatic beta cells which produce insulin

ABSOLUTELY insulin deficiency

Question 2

What is DKA

Answer 2

When the body breaks down fat as an alternative source of energy

This breakdown releases fatty acids into the blood stream leading to the production of ketone (acidic molecules)

Blood becomes too acidic = DKA

Question 3

Causes

Answer 3

Hereditary
Autoimmune
Environmental

Question 4

Examples of environmental

Answer 4

Low vit d exposure
Diet
Obesity
Exposure to a virus associated with islet inflammation - controviruses

Question 5

What random glucose confirms diagnosis

Answer 5

11 and +

Question 6

Symptoms

Answer 6

Thirst
Polyuria
Unexplained weight loss
Low healing wounds
Blurry vision
Reccurent infections (WBC are less effective in hyperglycemia)

Question 7

DKA symptoms

Answer 7

Same as T1DM but

Fruity smelling breath - due to ketones
N&V
Confusion
Loss of consciousness

Question 8

Can DKA occur if there is no hyperglycemias

Answer 8

Yes

Hyperglycaemia may not always be present — children and young people on insulin therapy may develop DKA with normal blood glucose levels.

Question 9

Which tests can be used

Answer 9

Random blood glucose - >11
Hbalc: >48
OGTT
Fasting glucose test
C-peptide - reflects production of insulin
Antoantibody test - GAD

Question 10

Does high or low c peptide indicate diabetics type 1

Answer 10

Low

Question 11

We know the complicates remember micro and macro

Question 12

Which electrolytes is decreased in dka

Answer 12

Potassium. (Can cause rythm disturbances)

Question 13

Basal bolus is first line, how does this work

Answer 13

Bolous - short acting given before meals

Basal - long or intermediate acting (background insulin)

Question 14

If patient cannot has basal bolus what other ones are there

Answer 14

Biphasic and continuous SC

Question 15

What’s included in the biphasic

Answer 15

1,2, or 3 injections per day

Rapid with intermediate - novorapid 30

Question 16

Explample of short acting

Answer 16

Humalin s

Question 17

Explample of intermediate?

Answer 17

Hamlin i

Question 18

Examples or rapid acting

Answer 18

Novorapid - insulin aspartus

Question 19

Long acting

Answer 19

Levimir - insulin detemir

Lantus - glargine

Question 20

Who would be recommended for the continuous sc

Answer 20

high HbA1c concentrations (69 mmol/mol [8.5%] or above)

Or disabling hypoglycaemia

Question 21

Which regimens are not recommended for newly diagnosed

Answer 21

Biphasic

Basal only

Bolous only

Question 22

What is included in the continuous SC

Answer 22

Rapid acting insulin anolouge

Question 23

Which anti diabetic drug can given for T1DM and to which types of patients?

Answer 23

BMI >25 (>23 in Asians) and want to minimise their effective insulin dose

Question 24

What are some risk factors of insulin

Answer 24

Hypoglycemia

Question 25

Which meds can mask hypo symptoms

Answer 25

Beta blockers can mask tachycardia and tremors

Question 26

Symptoms of hypos

Answer 26

Tachycardia Trmours Hungry Confused Dizzy

Question 27

Management of hypoglycemia if blood glucose above 4

Answer 27

Carb snack - bread

Question 28

Management of hypoglycemia if blood glucose under 4 and able to swallow

Answer 28

Fast acting glucose - glucose tablets

Question 29

After repeating that < after 15 mins up to 3 times and it fails as glucose levels are still under 4

Answer 29

IM glycogen or IV glucose

Question 30

Which educational programme is offered to all people with type 1 diabetes

Answer 30

DAFNE

Question 31

What blood glucose would you expect in dka

Answer 31

Over 11

Question 32

Management of DKA

Answer 32

Replace electrolytes and fluids Give soluble iv insulin (Same management for HHS)

Question 33

How often should hba1c be measured in general

Answer 33

Every 3-6 months

Question 34

Insulin moa

Answer 34

Stimulates glucose uptake and ultilsations from the blood stream into the tissues Inhibits glucogensis and ketogenesis Drives k into the cells

Question 35

Is aspirin used in primary prevention for CVD

Answer 35

No

Question 36

Self monitoring How often and when

Answer 36

At least 4 times per day for example before breakfast and 2 hours after meals, during periods of illness, before driving, and if they feel hypoglycaemic.

Question 37

Management of peripheral arterial disease

Answer 37

Clopidogrel

Question 38

Management of neuropathy

Answer 38

Deloxutine

Question 39

Erectile dysfunction

Answer 39

PED5 inhibitor - slidenafil