Type 1 Diabetes

Question 1

Define type 1 diabetes mellitus

Answer 1

Autoimmune disorder characterised by hyperglycaemia due to absolute insulin deficiency

Develops due to destruction of the insulin-producing beta cells of the Islets of Langerhans in the pancreas by the immune system

Question 2

What are the two key characteristics of type 1 diabetes

Answer 2

Absolute insulin deficiency

State of persistent hyperglycaemia

Question 3

When does type 1 diabetes typically present

Answer 3

Tend to develop in childhood/early adult life

Question 4

Diabetic ketoacidosis (DKA) is usually a first presentation of which type of diabetes

Answer 4

T1DM

Question 5

What is the name of the emergency condition associated with T1DM

Answer 5

Diabetic ketoacidosis (DKA)

Question 6

What causes the development of T1DM

Answer 6

• Mechanism is not fully understood
• The underlying cause is thought to be a combination of genetics and environmental triggers e.g. Enterovirus

Question 7

What produces insulin

Answer 7

Insulin is produced by the beta cells in the Islets of Langerhans in the pancreas

Question 8

Insulin functions to:

a) lowers blood glucose level
b) raises blood glucose level

Answer 8

Insulin functions to lowers blood glucose level

Background levels of insulin are always there but there is a rise with a rise in blood sugar levels

Question 9

Insulin acts to two-fold to reduced blood sugar.

What are these?

Answer 9

Tells cells of the body to absorb the glucose and use it as fuel

Stimulates glycogenesis i.e. formation of glycogen from glucose – in the muscles and liver

Question 10

What is glycogenesis

Answer 10

formation of glycogen from glucose

Question 11

Where is glycogen stored

Answer 11

In the muscles and liver

Question 12

Where is glucagon produced

Answer 12

Hormone produced by the alpha cells in the Islets of Langerhans in the pancreas

Question 13

Glucagon functions to:

a) lowers blood glucose level
b) raises blood glucose level

Answer 13

b) raises blood glucose level

Glucagon is used when glucose is gone

Question 14

Glucagon functions to raise glucose levels

What are the two ways in which it raises blood glucose levels

Answer 14

Stimulates glycogenolysis i.e. the breakdown of glycogen stores into glucose

Stimulates gluconeogenesis i.e. the conversion of fat and protein into glucose in the liver

Question 15

What is glycogenolysis

Answer 15

The breakdown of glycogen stores into glucose

Question 16

What is gluconeogenesis

Answer 16

The conversion of fat and protein into glucose in the liver

Question 17

When does Ketogenesis occur

Answer 17

Occurs when there is insufficient glucose supply and glycogens stores are exhausted

Question 18

What is ketogenesis

Answer 18

The liver takes fatty acids and converts them to ketone acids (ketones).

Question 19

What are ketones

Answer 19

Ketones are water soluble fatty acids that can be used as fuel.

They can cross the BBB and be used by the brain as fuel

The final product of ketogenesis - the conversion of fats into ketones

Question 20

What are the triad of symptoms for diabetes

Answer 20

Polyuria

Polydipsia

Weight loss

Question 21

What is polyuria?

Answer 21

Excessive production and passage of urine

Question 22

What is polydipsia

Answer 22

Increased thrist

Question 23

Why is intensive glycaemic control important?

Answer 23

Decrease the incidence of microvascular and macrovascular complications

Prevents emergency presentations e.g. DKA (T1DM), HHS (T2DM)

Question 24

Name the three microvascular complications of diabetes

Answer 24

Retinopathy

Nephropathy

Neuropathy

Question 25

Name three macrovascular complications of diabetes

Answer 25

Coronary artery Cerebrovascular Peripheral vascular disease

Question 26

How can you measure ketones

Answer 26

In the blood or urine

Question 27

The presence of C peptide can be useful to investigate T1DM. What are C peptides

Answer 27

C peptide is an amino acid that is released at the same time as insulin from the pancreas

Question 28

Name the three diabetes-specific autoantibody titres?

Answer 28

Anti-GAD (antibodies to glutamic acid decarboxylase) ICA (Islet cells antibodies) IAA (Insulin AutoAntibodies)

Question 29

Name two potential short term complications of T1DM

Answer 29

Hypoglycaemia DKA

Question 30

What are the three components of the T1DM management

Answer 30

Patient education Insulin therapy Monitoring

Question 31

Why should T1DM cycle their injection sites

Answer 31

To prevent lipodystrophy, condition in which the subcutaneous fat hardens which affects the absorption of insulin from that site.

Question 32

Patients are able to monitor their blood glucose level by capillary blood glucose monitoring kits. How many times a day are they recommended to check it

Answer 32

four times a day

Question 33

HbA1c indicates the average blood glucose concentration over a three-month period. What is the target level of HbA1c?

Answer 33

\<= 48mmol/mol

Question 34

Name the three types of insulin regimens

Answer 34

Basal-bolus Mixed (biphasic) regimen Continuous insulin infusion (insulin pump)

Question 35

Which insulin regiment is 1st line

Answer 35

Basal-bolus – best mimics the physiology

Question 36

Describe the basal bolus insulin regiments

Answer 36

Combination of long acting insulin for basal dosing and rapid-acting insulin for bolus dosing. Correction dose may be added to the bolus insulin based on the pre-meal blood glucose level. Offers flexibility to tailor insulin therapy with the carbohydrate load of each meal.

Question 37

Describe the mixed (biphasic) insulin regiment

Answer 37

Use of both short-acting and intermediate-acting insulin Can be a premixed product or the preparation can be mixed by the patient

Question 38

Describe the continuous insulin infusion (insulin pump) insulin regiment

Answer 38

Supplies regular amount via rapid or short acting insulin, which is delivered by a programmable pump and insulin storage reservoir via a subcutaneous needle or cannula

Question 39

Why sometiems after diagnosis are insulin levels low?

Answer 39

There may be some residual function of the beta cells Insulin requirement may suddenly rise as the remaing beta cells are destroyed