T1DM

Question 1

T1DM is a condition of relative/absolute insulin deficiency?

Answer 1

Absolute (T2DM is relative deficiency)

Question 2

What’s the normal fasting glucose result? (mmol/L)

Answer 2

6.0mmol/L and below

Question 3

What’s the normal 2-hour post OGTT glucose result?

Answer 3

7.7mmol/L and below

Question 4

Diabetes is indicated if a random glucose tested is above what (mmol/L)

Answer 4

11.1mmol/L

Question 5

Patients who are <1 year old are unlikely to develop T1DM. Why?

Answer 5

T1DM is an autoimmune condition - it usually takes years for the full beta-islet destruction to occur.

Question 6

T1DM can be detected through antibody screening prior to clinical symptom onset. True/false?

Answer 6

True, this is “latent autoimmune T1DM”

Question 7

T1DM tends to present in pre-school/school/high-school?

Answer 7

Pre-school and around puberty

Question 8

Microvascular complications of T1DM are usually present upon diagnosis. True/false?

Answer 8

False

Question 9

Typical presenting symptoms of T1DM (6)

Answer 9

1) Thirst
2) Polyuria
3) Weakness fatigue
4) Blurry vision
5) Thrush
6) UTI infections

Question 10

Which tests can differentiate T1DM from T2DM?

Answer 10

Type 1: GAD / anti-Islet antibodies present, ketonuria, C-peptide will be low in T1DM (high in T2DM)

Question 11

“Type 3 diabetes” commonly refers to that which is…

Answer 11

Secondary to other disease (e.g. pancreatic disease), drug induced, caused by genetic abnormalities

Question 12

HbA1C provides a snapshot of insulin control over which time-frame?

Answer 12

Previous 2-3 months

Question 13

The macrovascular complications of diabetes include (3)

Answer 13

1) Heart disease and stroke
2) Foot ulcer
3) Peripheral vascular disease

Question 14

The microvascular complications of diabetes include (3)

Answer 14

1) Retinopathy
2) Neuropathy
3) Nephropathy

Question 15

What’s the strongest established risk factor for development of T1DM?

Answer 15

Monozygotic twin has T1DM (30-50% risk)

Question 16

What’s the general population risk for developing T1DM?

Answer 16

1:250 to 1:300

Question 17

If both parents have T1DM, how likely is a child to develop it?

Answer 17

30%

Question 18

What carries greater risk; a mother or father with T1DM?

Answer 18

Father

Question 19

HLA genes represent what % of familial risk for T1DM?

Answer 19

50%

Question 20

Which two HLA-types are the highest risk for development of T1DM? What’s the increased fold in risk?

Answer 20

DR3-DQ2
DR4-DQ8

19-fold risk

Question 21

The diagnoses of T1DM has a seasonal variation. True/false?

Answer 21

True (more made in winter months)

Question 22

Can viral infection trigger T1DM?

Answer 22

Yes

Question 23

C-peptide loss is one of the first signs of T1DM. True/false?

Answer 23

False - C-peptide is the LAST factor to be lost.

Question 24

Classical triad of symptoms for T1DM?/

Answer 24

Polyuria (may present with enuresis in children), polydipsia, weight loss

Question 25

Describe the difference between basal and bolus insulins?

Answer 25

Basal insulin = a long acting insulin (usually given OD) | Bolus = a "with-meals" regimen

Question 26

What's the target HbA1c for T1DM?

Answer 26

48-58mmol/L

Question 27

T1DM accounts for which % of diabetes diagnoses in those <25 years old?

Answer 27

90%

Question 28

How many T1DM will have CF?

Answer 28

20%

Question 29

Insulin is secreted into which structure?

Answer 29

Hepatic portal vein

Question 30

Do T1DM tend to present with HHS or DKA?

Answer 30

DKA

Question 31

LADA is defined as

Answer 31

Presence of pancreatic auto-antibodies in patients with recently diagnosed diabetes in patients who do NOT require insulin

Question 32

LADA is AKA

Answer 32

"slowly progressive T1DM"

Question 33

When should LADA be considered? (4)

Answer 33

1) Autoantibody positive 2) Non-insulin requiring at positive 3) Associated with other autoimmune conditions 4) Non-obese

Question 34

Around what % of CF patients develop T1DM?

Answer 34

25%

Question 35

Wolfram Syndrome encompasses (4)

Answer 35

1) Diabetes Insipidus 2) DM 3) Optic atrophy 4) Deafness

Question 36

Bardet-Biedl Syndrome signs (3), what's it associated with?

Answer 36

Signs: obese, polydactyly, visual impairment. Associated with consanguineous marriage (2nd cousins or closer)

Question 37

What's the prevalence of coeliac disease in T1DM patients?

Answer 37

1:20

Question 38

Coeliac disease antibody test

Answer 38

anti-TTG positive

Question 39

Thyroid disease is how common in T1DM?

Answer 39

1:20

Question 40

Can T1DM be diagnosed on a single fasting glucose >7.0mmol/L?

Answer 40

No, requires symptoms OR a repeat testing

Question 41

T1DM often needs antibodies to confirm?

Answer 41

No, often on history (e.g. DKA)

Question 42

Signs of hypoglycaemia include (3)

Answer 42

1) Pallor 2) Tremor 3) Hunger

Question 43

Basal insulin normally accounts for around what % of insulin produced?

Answer 43

50% (rest is post-prandial)

Question 44

Target blood glucose for T1DM patients pre-meals?

Answer 44

3.9-7.2mmol/L

Question 45

Target blood glucose for T1DM post-meal?

Answer 45

<10mmol/L

Question 46

NovoRapid is a rapid/long acting insulin.

Answer 46

Rapid

Question 47

Rapid insulin analogues tend to have peak action after how long?

Answer 47

60-90 minutes

Question 48

How long do rapid- | insulin analogues typically last?

Answer 48

4-5 hours

Question 49

ActRapid and Humulin S are examples of what insulin type?

Answer 49

Soluble insulin analogues

Question 50

Soluble insulin tends to peak after how ong?

Answer 50

2-4 hours

Question 51

Humulin I is a basal / bolus insulin?

Answer 51

Basal

Question 52

Lantus (Glargine) is basal / bolus insulin?

Answer 52

Basal

Question 53

DAFNE is used in T1DM. True/false?

Answer 53

True - Dose Adjustment for Normal Eating

Question 54

Insulin pumps continuously inject short / long acting insulin?

Answer 54

Short-acting

Question 55

Insulin pumps are only designed to adminster basal doses of insulin. True/false?

Answer 55

False - can give boluses

Question 56

Metabolic control in T1DM can be measured through which laboratory investigations? (3)

Answer 56

1) BG monitoring 2) Urinalysis 3) HbA1c

Question 57

The formation of HbA1c is enzymatic. True/false?

Answer 57

False - occurs naturally in response to a high glucose

Question 58

What's the injection site complication of multiple insulin injections?

Answer 58

Lipohypertrophy

Question 59

What are the top 3 errors in prescribing insulin?

Answer 59

1) Wrong dose 2) Omitted medicine (i.e. someone has given a dose before & not recorded) 3) Wrong type of insulin

Question 60

Should insulin be omitted if patient is hypoglycaemic?

Answer 60

No - treat hypoglycaemia but continue insulin (prevents reactive hyperglycaemia)

Question 61

What's the general aim of diet in management of T1DM/

Answer 61

Consistent quantities of CHO

Question 62

Name an advanced carbohydrate counting programme.

Answer 62

DAFNE

Question 63

Does advanced calorie counting lead to long-term benefit?

Answer 63

Not really (no evidence for change in weight loss or lipid profile)

Question 64

What are the short-term (6 month) effects of advanced calorie counting? (3)

Answer 64

Better HbA1c, more freedom of diet, increased QoL

Question 65

What is the standard treatment in early-stages of hypoglycaemia?

Answer 65

15-20g simple carbohydrate

Question 66

List the most common causes of hypos (3)

Answer 66

1) Missed/delayed meal 2) Not enough CHO in last meal 3) Increased exercise

Question 67

Patients are safe from hypos 6 hours after exercise. True/false?

Answer 67

False - can occur 12-24 hours after exercise. (esp if exercise is >60 minutes moderate)

Question 68

Why should exercise be avoided in low insulin states?

Answer 68

Leads to low glucose absoprtion into muscles and muscles will secrete glucagon which can cause hyperglycaemia

Question 69

True/false: sucrose has a different profile than other CHOs?

Answer 69

False

Question 70

Sweetners are always non-nutritive (i.e. cannot be reduced to CHOs)?

Answer 70

False

Question 71

Diabetic foods should be recommended to diabetic patients, true/false?

Answer 71

False

Question 72

Low GI foods raise BG slowly. True/false?

Answer 72

True

Question 73

In practice, low GI foods should be recommended. True/false?

Answer 73

False - no evidence to suggest benefit, more important is total CHO content

Question 74

Is there evidence to suggest all DM patients should be given vitamin supplements?

Answer 74

No, only benefit if there is a deficiency