Type 1 Diabetes

Question 1

Define Type 1 Diabetes.

Answer 1

• Hyperglycaemia due to ABSOLUTE INSULIN DEFICIENCY
• Destruction pancreatic beta cells by immune mediated mechanisms
• Accounts for 5-10% of all patients with diabetes
• Usually juvenile onset

Question 2

What are the risk factors for T1DM?

Answer 2

Young age
Caucasian - Northern Europe
30-50% concordance identical twins
HLA DR3/DR4 - islet cell antibodies
Increase incidence with Coeliac Disease

Question 3

What are the symptoms of T1DM?

Answer 3

Polyuria
Polydipsia
Nocturia
Weight loss
N+V
Blurred vision
SOB
Lethargy
Abdominal pain

NB: Many first time presentation with KETOACIDOSIS

Question 4

What are the investigations for T1DM?

Answer 4

1. RANDOM GLUCOSE PLASMA TEST
   Diabetes =
   >11.1 mmol/L
   + SYMPTOMS

NB: Typical T1DM Patient

• Ketosis.
• Rapid weight loss.
• Age of onset younger than 50 years.
• Body mass index (BMI) below 25 kg/m2.
• Personaland/or family history ofautoimmune disease.

IF positive need same-day referral to diabetic specialist

2. URINALYSIS
   - Plasma/urine ketones = +ve

3.ANTIBODY TESTING
Anti-glutamic acid decarboxylase (GAD) & islet antigen 2 antibodies = +ve

Question 5

What is the conservative management for type 1 diabetics?

Answer 5

• Healthy eating
• Education programs so patients may tailor insulin regimes to their diet
• Exercise to reduce vascular disease
• Stop smoking

Question 6

What is the medical management for type 1 diabetes?

Answer 6

BASAL-BOLUS INSULIN (1st line)

• BASAL = intermediate and long-acting injections to cover basal dose of insulin
• BOLUS = short/rapid acting injections to cover meal times

NB: Can be insulin pump mix

ADJUNCT

• Pre-meal insulin correction dose
• Amylin analogue (reduces post-pradial glucose by increasing gastric emptying and decreasing glucagon secretion)

FIXED DOSE INSULIN (2nd line)

Question 7

What HbA1C level is the aim for management?

Answer 7

<6.5 %

Question 8

What screening tests are done for diabetic complications?

Answer 8

ANNUAL =

• Fundoscopy
• Feet examination
• Neurological examination
• Vascular examination
• Check insulin sites
• BP monitoring
• Monitor renal function
• Thyroid function