Type 1 Diabetes

Question 1

What are the investigations for Type 1 DM?

Answer 1

• Urine dip for glucose and ketones.
• Fasting glucose (>7.0) and random glucose (>11.1) (if asymptomatic then must be demonstrated on two separate occasions)
• C-peptide (co-released with insulin) will be low,
• Diabetes specific autoantibodies: Auto-antibodies eg, Anti IA2, Anti-GAD, Anti-CAD

Question 2

Name the autoantibodies associated with type 1 diabetes

Answer 2

• Anti-islet cell antibodies
• Anti-GAD antibodies
• Anti-insulin antibodies

Question 3

What is the symptoms of type 1 diabetes

Answer 3

Classic triad of hyperglycaemia
* Polyuria,
* Polydipsia
* Weigh loss (mainly through dehydration)

Alternatively the first presentation can be DKA

Question 4

What are the causes of Type 1 DM

Answer 4

• Genetic compounant
• Certain viral infections eg, Coxsackie B or enterovirus

Autoimmune disease can be tirggered by viral infections

Question 5

Reminder: What cells of the pancreas produce insulin?

Answer 5

Beta cells.
Alpha cells make glucagon (released in response to low blood sugar levels0

Question 6

Explain the diagnosis of T1DM

Answer 6

Fasting glucose >7mmol/L,
Random plasma glucose .11.1mmol/L,
HbA1c .6.5% or 48mmol/mol.

If symptomatic then only need this once. If asymptoamtic then results must be demonstrated on two seperate occasions

Question 7

Explain the monitoring of T1DM

Answer 7

• Monitor HbA1c every 3-6 months,
• Self monitoring glucose 4x daily (before each meal and bed)
• Target blood sugars between 5-7mmol on waking and 4-7 before meals/other times of day)

Question 8

What are the insulin options for Type 1 diabetes?

Answer 8

• Insulin of choice for adults is basal-bolus.
• Basal = long acting eg, Levemir (given twice daily),
• Bolus = meal time insulin eg, lispro

Other regimes include once daily and twive daily