Type 1 Diabetes

Question 1

What is Type 1 diabetes characterised as?

Answer 1

An autoimmune disorder causing pancreatic beta-cell destruction (absolute insulin deficiency)

Question 2

What is the classic clinical presentation for T1DM?

Answer 2

Pre-school and peri-puberty, usually lean, acute, severe weight loss, ketonuria, candidal infection, 4T’s - toilet, thirsty, tired, thinner

Question 3

What is the classic triad of symptoms in T1DM?

Answer 3

Polyuria (frequent peeing), polydipsia (thirstiness) and weight loss

Question 4

What is the pathogenesis of Type 1 DM?

Answer 4

Question 5

Which auto-antibodies are associated with Type 1 Diabetes?

Answer 5

Glutamic acid decarboxylase (GAD 65Ab), Islet-antigen 2 (IA-2Ab), Insulin (IAA) and ZnT8 transporter

Question 6

What auto-immune conditions are associated with T1DM?

Answer 6

• Thyroid disease • Coeliac disease • Pernicious Anaemia • Addison’s disease • Polyglandular Endocrinopathy

Question 7

Which genes are associated with Type 1 Diabetes?

Answer 7

Human Leukocyte Antigen (HLA)

Question 8

When should you question diagnosis of T1DM in youth?

Answer 8

• Diabetes diagnosed < 6 months (?neonatal) - Family history of DM [parent] (?MODY) - Detectable insulin production ≥ 3 years after diagnosis - Undetectable pancreatic antibodies {at diagnosis}

Question 9

What are the 2 main components of normal insulin secretion?

Answer 9

Basal secretion and prandial responses (post-meals)

Question 10

In normal insulin secretion, what is the normal insulin response to meals?

Answer 10

Biphasic: 1) Rapid phase of pre-formed insulin lasts 5 to 10 mins 2) Slow phase over 1 to 2 hours.

Question 11

What kind of insulin are Homalog, Novorapid and apidra examples of?

Answer 11

Rapid-acting analogue

Question 12

What kind of insulin are Humulin S, Actrapid and Insuman Rapid examples of?

Answer 12

Short-Acting (soluble/regular)

Question 13

What kind of insulin are Insulatard, Humulin I and Insuman basal examples of?

Answer 13

Intermediate (Isophane - Basal)

Question 14

What kind of insulin are Lantus, Levemir or Degludec examples of?

Answer 14

Long acting analogue

Question 15

What kind of insulin are Homalog Mix 25/50 or NovoMix 30 examples of?

Answer 15

Rapid acting analogue-intermediate mixture

Question 16

What kind of insulin are Humulin M3 or Insuman Comb 15/25/50 examples of?

Answer 16

Short acting-intermediate mixture

Question 17

What ratio should insulin regime be divided between prandial and basal?

Answer 17

50/50

Question 18

How do insulin pumps work?

Answer 18

Continuous administration of short acting insulin subcutaneously. 1) Deliver background insulin dictated by BASAL rate - programmed in advance and may be set to different rates at different times of the day. 2) Deliver manually activated BOLUS’ of insulin to cover meals (calculated by CHO counting)

Question 19

In what ways can metabolic control be evaluated?

Answer 19

• Home Blood Glucose Monitoring (fingersticking) - Urine Testing (Glucose/ Ketones) - Glycated Hemoglobin (HbA1C) - Continuous glucose monitor - ideal

Question 20

What factors limit insulin injection/pumps vs the natural system?

Answer 20

• Enters subcutaneous tissue rather than direct to blood stream • Peak too slow to prevent post-meal hyperglycaemic spike • Slow clearance

Question 21

When should IV insulin be given?

Answer 21

• Diabetic Ketoacidosis (DKA) - Hyperosmolar Hyperglycaemic State (HHS) - Acute illness - Fasting patients who are unable to tolerate oral intake

Question 22

When are Pancreatic Islet transplantations indicated?

Answer 22

• Episodes of severe hypoglycaemia • Severe and progressive long-term complications despite maximal therapy • Uncontrolled diabetes despite maximal treatment