Type 1 Diabetes

Question 1

Identify three clinical features of T1DM

Answer 1

• Polyuria
• Polydipsia
• Weight loss

Question 2

What random plasma glucose concentration is indicative of T1DM?

Answer 2

• Greater than 11 mmol/l

Question 3

What fasting plasma glucose is indicative of T1DM?

Answer 3

• Greater than 6.9 mmol/l

Question 4

How long should a patient be fasted for when performing a fasting plasma glucose?

Answer 4

• 8 hours

Question 5

What does HbA1c reflect?

Answer 5

• Degree of hyperglycaemia over preceding 3 months

Question 6

What HbA1c concentration is indicative of T1DM?

Answer 6

• Greater than 48 mmol/l

Question 7

Identify two further investigations (and their results) that can be used to differentiate between T1DM and T2DM

Answer 7

• C-peptide: Negative

- Anti-GAD: Positive

Question 8

What is the diagnostic criteria for symptomatic people?

Answer 8

• Random plasma glucose greater than 11 mmol/l

OR

• HbA1c greater than 48 mmol/L

Question 9

What is the diagnostic criteria for asymptomatic people?

Answer 9

• Random plasma glucose greater than 11 mmol/l AND fasting glucose greater than 6.9

OR

• HbA1c greater than 48 mmol/L

Question 10

When should a patient be referred to a diabetic specialist team?

Answer 10

• On the same day

Question 11

Identify 3 differential diagnoses of T1DM

Answer 11

• MODY
• Neonatal diabetes
• Type 2 diabetes
• LADA

Question 12

How many times a year should a child attend a diabetes clinic?

Answer 12

• 4

Question 13

How often should dental examinations be performed?

Answer 13

• Every 4-6 months

Question 14

How often should eye examination be performed?

Answer 14

• Every 2 years

Question 15

What is a multiple daily injection basal bolus insulin regimen?

Answer 15

• Intermediate insulin (isophane) for basal dosing once daily
• Short acting insulin (aspart) for bolus dosing before meals

Question 16

What is the daily dose of insulin during childhood and then following puberty?

Answer 16

• 0.5 to 1 units /kg/day in childhood

- 1 to 1.5 units/kg/day following puberty

Question 17

What is a honeymoon period?

Answer 17

• Partial remission phase involving a low dose of insulin that is sufficient to maintain HbA1c under target

Question 18

Identify 3 criteria for continuous subcutaneous insulin infusion (insulin pump)

Answer 18

• MDI causes hypoglycaemia
• MDI is inappropriate or impractical
• HbA1c remains high despite high level of care

Question 19

What is the target HbA1c in children?

Answer 19

• 48 mmol/mol

Question 20

How many capillary blood glucose tests should be performed each day in children?

Answer 20

• 5

Question 21

What are the optimum targets for short term glucose control in children?

Answer 21

• 4 - 7 on waking
• 4 - 7 before meals
• 5 - 9 after meals

Question 22

What should be monitored once yearly?

Answer 22

• Thyroid disease
• Albuminuria (ACR 3-30 mg/mmol)
• Hypertension
• Retinopathy
• Diabetic foot

Question 23

Identify three sick day rules

Answer 23

• Never stop insulin
• Check blood glucose more frequently (every 2 hours)
• Maintain adequate fluid intake (3L)
• Maintain normal meal patterns
• Seek medical advice if violently sick, drowsy or unable to keep fluid down

Question 24

Identify basal and bolus dosing for MDI in adults

Answer 24

• Basal: Long acting insulin (detemir) once daily

- Bolus: Short acting insulin (aspart) before meals

Question 25

When should metformin be considered in T1DM? Why?

Answer 25

- BMI greater than 25 kg/m2 | - Causes weight loss.

Question 26

Outline the criteria for starting antihypertensive medication in T1DM

Answer 26

- No albuminuria or features of metabolic syndrome = 135/85 | - Albuminuria + 2 or more features of metabolic syndrome = 130/80

Question 27

What is the initial antihypertensive treatment in T1DM?

Answer 27

- ACE inhibitor (Ramipril)

Question 28

Identify three criteria for prescribing atorvastatin in T!DM

Answer 28

- Older than 40 - Has had diabetes more than 10 years - Established nephropathy - Other CVD risk factors

Question 29

What is the target HbA1c in adults with T1DM?

Answer 29

- Less than 48 mmol/mol

Question 30

How often should HbA1c be measured in in adults with T1DM?

Answer 30

- Every 3 - 6 months

Question 31

What are the short-term plasma glucose target ranges in adults?

Answer 31

- Fasting: 4 - 7 - Before meals: 4 - 7 - After meals: 5 - 9 - When driving: At least 5

Question 32

Identify three conditions in which more regular glucose testing is required?

Answer 32

- Desired glucose target is not achieved - Frequency of hypoglycaemic episodes increases - During periods of illness - Before, during, and after sports - Before driving