Type 1 Diabetes Flashcards
(35 cards)
What are the typical symptoms and signs in a new diagnosis of type 1 diabetes mellitus (T1DM)?
Symptoms: (4 Ts - Tired, Toilet, Thirsty, Thinner)
* Polyuria
* Fatigue
* Polydipsia
* Weight loss
Symptoms include abdominal pain, polyuria, polydipsia, dehydration, Kussmaul respiration, and acetone-smelling breath.
List four features of diabetic ketoacidosis (DKA).
- Abdominal pain
- Polyuria
- Polydipsia
- Dehydration
- Kussmaul respiration
- Acetone-smelling breath
What investigations should be performed for suspected type 1 diabetes mellitus?
- Urine dip for glucose and ketones
- Fasting glucose
- Random glucose
- C-peptide levels
- Diabetes-specific autoantibodies
Why is HbA1c not as useful for patients with a possible diagnosis of T1DM?
It may not accurately reflect a recent rapid rise in serum glucose.
What is the typical C-peptide level in patients with T1DM?
Typically low.
Which antibodies are seen in type 1?
- Antibodies to glutamic acid decarboxylase (anti-GAD)
- Islet cell antibodies (ICA)
- Insulin autoantibodies (IAA)
What are the diagnostic criteria for type 1 diabetes mellitus if the patient is symptomatic?
- Fasting glucose ≥ 7.0 mmol/l
- Random glucose ≥ 11.1 mmol/l
If the patient is symptomatic with these reults diagnosis can occur straight away. If the patient is asympomatic then these results must be seen on 2 separate occasions!!!
What is the typical age of onset for type 1 diabetes?
Typically < 20 years, but 40% can be > 30 years.
What characterizes the speed of onset for type 1 diabetes?
More acute, occurring over hours to days.
What is a typical weight characteristic of patients with type 1 diabetes?
Recent weight loss is typical.
What features are commonly seen in type 2 diabetes compared to type 1 diabetes?
- Milder symptoms (e.g., polyuria, polydipsia)
- Obesity is a strong risk factor
- Ketonuria is rare
What are the typical features of type 1 diabetes that may guide diagnosis according to NICE?
- Ketosis
- Rapid weight loss
- Age of onset below 50 years
- BMI below 25 kg/m²
- Personal and/or family history of autoimmune disease
How often should HbA1c be monitored in adults with type 1 diabetes?
Every 3-6 months.
What is the target HbA1c level for adults with type 1 diabetes according to NICE?
48 mmol/mol (6.5%) or lower.
What factors should be considered when determining HbA1c targets?
- Daily activities
- Aspirations
- Likelihood of complications
- Comorbidities
- Occupation
- History of hypoglycaemia
How many times a day should individuals with type 1 diabetes test their blood glucose?
At least 4 times a day.
When is more frequent blood glucose monitoring recommended?
- Increased frequency of hypoglycaemic episodes
- During periods of illness
- Before, during, and after sport
- When planning pregnancy
- During pregnancy
- While breastfeeding
What are the blood glucose targets for individuals with type 1 diabetes?
- 5-7 mmol/l on waking
- 4-7 mmol/l before meals at other times of the day
What type of insulin regimen is recommended for adults with type 1 diabetes?
Multiple daily injection basal-bolus insulin regimens.
What is the regime of choice for twice-daily insulin for adults?
Insulin detemir.
What is an alternative to twice-daily insulin detemir?
Once-daily insulin glargine or insulin detemir.
What type of insulin should be offered for mealtime insulin replacement?
Rapid-acting insulin analogues.
What should be considered when adding metformin for patients with type 1 diabetes?
If the BMI >= 25 kg/m².
What are the categories of insulin based on duration of action?
- Rapid-acting insulin analogues
- Short-acting insulin
- Intermediate-acting insulin
- Long-acting insulin analogues
- Premixed preparations
Each category has specific characteristics related to onset, peak, and duration.
