T1DM

Question 1

which phenotypes are more susceptible to T1DM

Answer 1

HLA DR3-DQ2

HLA DR4-DQ8

Question 2

type of insulin deficiency in T1DM

Answer 2

absolute

Question 3

what happens in hyperglycaemia

Answer 3

increased gluconeogensis and glycogenolysis,

increased counter-regulatory hormones

Question 4

what are the counter regulatory hormones

Answer 4

glucagon, cortisol, growth hormone, adrenaline

Question 5

what is the cause of weight loss in type 1 diabetes

Answer 5

increased lipolysis and lipase suppression

Question 6

cause of recurrent infection in diabetes

Answer 6

delayed wound healing, recurrent hospital admissions, immune system damage

Question 7

cause of Kussmaul breathing

Answer 7

involuntary attempt to remove CO2 from blood in late stage DKA

Question 8

how does Kussmaul breathing present

Answer 8

deep/labored hyperventilation, acetone smell

Question 9

risk factors for developing hyperglycaemia

Answer 9

corticosteroids, TPN, NG

Question 10

risk factors for developing hypoglycaemia

Answer 10

eating less, vomiting, corticosteroids, TPN, NG, acute kidney injury

Question 11

presentation of hypoglycaemia

Answer 11

pallor, sweat, tremor, palpitations, confusion, nausea, hunger, tired, coma

Question 12

differential for T1DM

Answer 12

T1DM, T2DM, diabetes insipidus, UTI, hypercalcaemia

Question 13

when to admit a patient to secondary care in a T1DM diagnossi

Answer 13

if DKA, ketonaemia, vomiting

Question 14

what is needed for a diagnosis of T1DM

Answer 14

fasting glucose >7.0 + random glucose >11.1

+ symptoms OR repeat test

Question 15

name the auto-antibodies in T1DM

Answer 15

GAD, IA2, IAA, ZnT8

Question 16

which auto-antibody is most likely to be present at diagnosis of T1DM

Answer 16

GAD

Question 17

histological appearance of T1DM

Answer 17

insulitis, lymphocytic infiltrate

Question 18

standard dosage of insulin

Answer 18

100 units

Question 19

best sites for administering insulin

Answer 19

abdomen, upper outer thigh/arm, buttock

Question 20

tips for administering insulin

Answer 20

rotate site, inject into subcutaneous fat not muscle or too superficial

Question 21

side effects of administering insulin

Answer 21

lipohypertrophy, injection site inflam/infection

Question 22

what additional blood test (not autoantibodies or true blood glucose) is useful

Answer 22

c peptide

Question 23

does beta-hydroxybutyrate or acetoacetate cause ketonaemia

Answer 23

beta-hydroxybutyrate

Question 24

does beta-hydroxybutyrate or acetoacetate cause ketonuria

Answer 24

acetoacetate

Question 25

what does the anion gap show in dka

Answer 25

raised anion gap shows ketoacidosis

Question 26

is lactate increased or decreased in DKA

Answer 26

increased

Question 27

management of DKA

Answer 27

O2
500ml 0.9% NaCl in 30 min
10% dextrose
LMWH
IV insulin

Question 28

management of a patient in hospital unconscious due to a hypoglycaemic episode

Answer 28

stop IV insulin; IV glucose or IJ glucagon

Question 29

management of a hypoglycaemic episode in a patient who is drowsy or confused

Answer 29

PO glucose gel

Question 30

management of a hypoglycaemic episode in a patient who is NOT drowsy or confused

Answer 30

15-20g quick acting carb; 60ml glucojuice, 150ml juice

Question 31

how soon after give a quick acting carb should you re-check blood glucose in a hypoglycaemic episode

Answer 31

15 minutes

Question 32

should you stop insulin in a patient with a hypoglycaemic episode who can tolerate food

Answer 32

no