Type 1 diabetes

Question 1

What is type 1 diabetes?

Answer 1

A condition in which the pancreas stops being able to produce adequate insulin

Question 2

What is hyperglycaemia?

Answer 2

High blood glucose concentrations

Question 3

What is hypoglycaemia?

Answer 3

Low high glucose concentrations

Question 4

What is the classic triad of symptoms of hyperglycaemia?

Answer 4

Polyuria
Polydipsia
Weight loss

Question 5

What is the recommended blood glucose concentration?

Answer 5

Between 4.4 and 6.1mmol/L

Question 6

Where is insulin produced?

Answer 6

Beta cells in the Islets of Langerhans in the pancreas

Question 7

What is insulin?

Answer 7

An anabolic hormone that reduces blood sugar levels

Question 8

What are the two ways in which insulin works?

Answer 8

It causes cells in the body to absorb glucose for fuel

It causes muscle and liver cells to absorb glucose and store it as glycogen (glycogenesis)

Question 9

Where is glucagon produced?

Answer 9

Alpha cells in the Islets of Langerhans in the pancreas

Question 10

What is glucagon?

Answer 10

A catabolic hormone released in response to low blood sugar levels and stress

Question 11

What are the two things that glucagon does?

Answer 11

It tells the liver to break down stored glycogen and release it as glucose (glycogenolysis)

It tells the liver to convert proteins and fats into glucose (gluconeogenesis)

Question 12

What is the production of ketones called?

Answer 12

Ketogenesis

Question 13

When does ketogenesis occur?

Answer 13

When there is insufficient glucose supply and glycogen stores and exhausted e.g. prolonged fasting

Question 14

How are ketones produced?

Answer 14

Fatty acids

Question 15

How are ketone levels measured in the urine?

Answer 15

Urine dipstick

Question 16

How are ketone levels measured in the blood?

Answer 16

Ketone meter

Question 17

What is the characteristic sign of diabetic ketoacidosis?

Answer 17

Acetone smelling breath

Question 18

What are the common presentations of diabetic ketoacidosis?

Answer 18

Initial presentation of diabetes

Type 1 diabetic who is acutely unwell

Type 1 diabetic who is not adhering to an insulin regime

Question 19

What are the three key features of diabetic ketoacidosis?

Answer 19

Ketoacidosis
Dehydration
Potassium imbalance

Question 20

How do kidneys counteract ketone acids in the blood to maintain an normal pH?

Answer 20

They produce bicarbonate which neutralises to acidic ketones

Question 21

What is the typical presentation of someone with diabetic ketoacidosis?

Answer 21

Polyuria
Polydipsia
Acetone smell to breath
Nausea and vomiting
Altered consciousness / confusion

Question 22

What three things does a diagnosis of diabetic ketoacidosis require?

Answer 22

Hyperglycaemia - blood glucose of 11mmol/L or more

Ketosis - blood ketones above 3mmol/L

Acidosis - pH below 7.3

Question 23

What is the initial management of diabetic ketoacidosis?

Use FIG-PICK mnemonic

Answer 23

Fluids - IV saline
Insulin - fixed rate infusion
Glucose - monitor

Potassium - add to IV fluids
Infection - check
Chart fluid balance
Ketones - monitor

Question 24

What are complications in the management of diabetic ketoacidosis?

Answer 24

Hypoglycaemia
Hypokalaemia
Cerebral oedema
Pulmonary oedema

Question 25

How is type 1 diabetes managed?

Answer 25

Monitoring dietary carbohydrates Monitoring blood sugar levels Subcutaneous insulin

Question 26

What is lipodystrophy?

Answer 26

Hardening of subcutaneous fat as a result of administering insulin injections into the same spot repeatedly

Question 26

What is a basal-bolus regime of insulin?

Answer 26

A once-daily long-acting insulin injection combined with short-acting insulin injections 30 minutes before consuming carbohydrates

Question 27

What is an insulin pump?

Answer 27

A device that continuously infuse insulin to control blood sugar levels

Question 28

What are some advantages of insulin pumps?

Answer 28

Better blood sugar control Flexibility with eating Less injections

Question 29

What are some disadvantages of insulin pumps?

Answer 29

Continuous attachment Infusion sets can become blocked Slightly higher risk of infection

Question 30

What is HbA1c?

Answer 30

A measure of glycated haemoglobin (how much glucose is attached to haemoglobin molecules)

Question 31

What does HbA1c reflect?

Answer 31

The average glucose level over the previous 2-3 months

Question 32

What is done to measure blood glucose with a monitor?

Answer 32

Capillary blood glucose by finger-prick test

Question 33

What should always be done if hypoglycaemia is suspected?

Answer 33

Capillary blood glucose testing

Question 34

What are common symptoms in hypoglycaemia?

Answer 34

Hunger Tremor Sweating Irritability Dizziness Pallor

Question 35

How should hypoglycaemia be treated?

Answer 35

Rapid-acting glucose should be given initially (oral or subcut / IV) Once the blood glucose rises a slower-acting carbohydrate should be given (biscuits, toast)

Question 36

Name some macrovascular complications of type 1 diabetes?

Answer 36

Coronary artery disease Peripheral ischaemia Diabetic foot ulcers Stroke Hypertension

Question 37

Name some microvascular complications of type 1 diabetes?

Answer 37

Peripheral neuropathy Retinopathy Nephropathy

Question 38

Name some infection-related complications of type 1 diabetes?

Answer 38

Fungal infections - candidiasis Urinary tract infections Pneumonia Skin / soft tissue infections