Type 1 Diabetes

Question 1

What is type 1 DM

Answer 1

Type 1 diabetes mellitus (T1DM) is an autoimmune condition in which the immune system targets and destroys the insulin-producing cells of the pancreas.

Question 2

What is the presentation of T1DM initially

Answer 2

As the body’s production of insulin gradually decreases, children start to exhibit characteristic signs of polyuria, polydipsia and weight loss.

Question 3

What BM is required during random glucose test to confirm DM

Answer 3

random BM > 11.0 mmol/L

Question 4

What fasting glucose level indicates DM

Answer 4

(>7.0 mmol/L).

Question 5

What is used for DM diagnosis

Answer 5

The diagnosis of type 1 diabetes is made through raised blood glucose measurements (random BM > 11.0 mmol/L), along with other markers like raised HbA1c, urine ketones and raised fasting glucose (>7.0 mmol/L).

Question 6

What is polyuria

Answer 6

Urinate lots

Question 7

What is polydypsia

Answer 7

Constant thirst

Question 8

Why does potassium imbalance occur

Answer 8

Insulin normally drives potassium into cells. Without insulin potassium is not added to and stored in cells.

Question 9

How can hypokalaemia arise

Answer 9

Serum potassium can be high or normal as the kidneys continue to balance blood potassium with the potassium excreted in the urine, however total body potassium is low because no potassium is stored in the cells. When treatment with insulin starts patients can develop severe hypokalaemia (low serum potassium) very quickly and this can lead to fatal arrhythmias.

Question 10

What are the symptoms of hypoglycaemia

Answer 10

tremor, sweating, irritability, dizziness and pallor.

Question 11

What are the severe implications of hypoglycaemia

Answer 11

reduced consciousness, coma and death unless treated.

Question 12

How to treat hypoglycemia

Answer 12

treated with a combination of rapid acting glucose such as lucozade and slower acting carbohydrates such as biscuits and toast for when the rapid acting glucose is used up. Options for treating severe hypoglycaemia are IV dextrose and intramuscular glucagon.

Question 13

How to treat hyperglycemia (not DKA)

Answer 13

may require their insulin dose to be increased.

Question 14

What is the long term complication of hyperglycaemia

Answer 14

Chronic exposure to hyperglycaemia causes damage to the endothelial cells of blood vessels. This leads to leaky, malfunctioning vessels that are unable to regenerate.

Question 15

What do high glucose levels in the blood lead to

Answer 15

suppression of the immune system, and provides an optimal environment for infectious organisms to thrive.

Question 16

What are the microvascular complications

Answer 16

Coronary artery disease is a major cause of death in diabetics
Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”
Stroke
Hypertension

Question 17

What are the microvascular complications

Answer 17

Peripheral neuropathy
Retinopathy
Kidney disease, particularly glomerulosclerosis

Question 18

What are the infection related complications

Answer 18

Urinary Tract Infections
Pneumonia
Skin and soft tissue infections, particularly in the feet
Fungal infections, particularly oral and vaginal candidiasis

Question 19

What is measured in HbA1c

Answer 19

counting glycated haemoglobin, which is how much glucose is attached to the haemoglobin molecule. This is considered to reflect the average glucose level over the last 3 months because red blood cells have a lifespan of around 3-4 months. We measure it every 3 – 6 months to track progression of the patient’s diabetes and how effective the interventions are.