Type 1 DM

Question 1

What is the pathophysiology of T1DM?

Answer 1

insulin deficiency from autoimmune destruction of insulin secreting pancreatic beta cells

Question 2

What is the pathophysiology of T2DM/

Answer 2

↓insulin secretion ± ↑insulin resistance

Question 3

What is T1DM associated w?

Answer 3

HLA DR3/DR4

Question 4

What features point to a diagnosis of T1DM in adults?

Answer 4

1. Hyperglycaemia - random plasma glucose >11mmol/L
2. One or more of the following:
   - ketosis
   - Rapid weight loss
   - age of onset <50yrs
   - BMI <25
   - PMHx or FHx of autoimmune disease

Question 5

What features point to a diagnosis of T1DM in children/young people?

Answer 5

1. Hyperglycaemia - rapid plasma glucose >11mmol/L
2. Polyuria
3. Polydipsia
4. Weight loss
5. Excessive tiredness

Question 6

When would you suspect T2DM rather than type 1 in children/young people?

Answer 6

T2DM:

• strong FHx of T2DM
• obesity
• black/asian family origin
• No insulin requirement
• Evidence of insulin resistance

Question 7

What tests would u do to diagnose DM?

Answer 7

1. Random plasma glucose ≥11 mmol/L
2. Fasting plasma glucose - no caloric intake for at least 8hrs ≥6.9 mmol/L
3. Plasma/urine ketone - medium or high
4. HbA1c - ≥48 mmol/mol

Question 8

What is C-peptide?

Answer 8

byproduct formed when pro-insulin is processed to insulin so reflects insulin production
not measured routinely

Question 9

What level of fasting C-peptide indicates T1DM?

Answer 9

low or undetectable

indicates absence of insulin secretion from pancreatic beta cells

Question 10

What is the target HbA1c in T1DM?

Answer 10

48 or lower

Question 11

when should blood glucose be measured in children and young people w T1DM?

Answer 11

At least 5 a day

including before each meal and before bed

Question 12

What fasting plasma glucose should children/young people w T1DM aim for on waking?

Answer 12

4-7mmol/L

Question 13

What pre-prandial plasma glucose should children/young people w T1DM aim for

Answer 13

4-7mmol/L

Question 14

What post-prandial plasma glucose should children/young people w T1DM aim for?

Answer 14

5-9mmol/L

Question 15

What level plasma glucose should young people of driving age aim for in T1DM?

Answer 15

at least 5mmol/L

Question 16

How often should HbA1c be measured in T1DM?

Answer 16

Every 3-6mnths

Question 17

When should blood glucose be monitored more frequently in T1DM?

Answer 17

Increase in hypoglycaemic episodes
Periods of illness
Before during or after sport 
Planning and during pregnancy 
Breastfeeding

Question 18

What 2 types of insulin should those with T1DM be offered?

Answer 18

1. Background (long acting ) insulin injected twice a day

2. Quick acting (rapid acting) injected before each meal, deals w rise in BM from eating

Question 19

What insulin regimen should children + young people with T1DM be offered first?

Answer 19

MULTIPLE DAILY INJECTION BASAL-BOLUS INSULIN REGIMENS:
Injection of short/rapid acting insulin analogue before meals
+
1 or more daily injections of intermediate/long acting insulin analogue
I.e. rapid before meals + long acting background

Question 20

What are the other 2 basic types of insulin regimen?

Answer 20

1. Continuous subcut insulin infusion

2. One, two or three insulin injections per day - short/rapid + intermediate-acting insulin

Question 21

What insulin regimen should be offered to adults w T1DM?

Answer 21

multiple daily injection basal-bolus

Question 22

what drug can be added if insulin doesn’t control BM enough in T1DM?

Answer 22

Dapagliflozin w a BMI of ≥27

Question 23

How is insulin administered?

Answer 23

subcut

rotating injection sites to prevent lipodystrophy