Wk 9: Diabetes in practice: Type 1

Question 1

Define Type 1 diabetes

Answer 1

Absolute insulin deficiency causes persistent hyperglycaemia

Question 2

What are the assessment and diagnosis of children and young people with T1DM? Does this require immediate referral?

Answer 2

• Random plasma glucose
  > 11mmol/L
• Polyuria
• Polydipsia
• Weight loss
• Excessive tiredness
• Yes, immediate referral

Question 3

What are the assessment and diagnosis of adults with T1DM? Does this require immediate referral?

Answer 3

• Random plasma glucose >11mmol/L
• Ketosis
• Weight loss
• < 50
• BMI 25kg/m2
• Hx/Fx autoimmune diseases
• No

Question 4

What are the recommendations for how often you self-monitor blood glucose levels in T1DM?

Answer 4

• Min 4 times daily (before meals + bed)

- Inc to >4 during illness + driving

Question 5

What is the aim for HbA1c without disabling hypoglycaemia?

Answer 5

< 48mmol/mol (6.5%)

Question 6

How often must HbA1c levels be tested?

Answer 6

3-6 months

Question 7

What is considered good in the HbA1c range

Answer 7

41mmol/mol (5.9%) - 49mmol/mol (6.6%)

Question 8

What is the natural profile of insulin?

Answer 8

• Basal = steady low level background insulin

- Meal time bolus = inc secretion in response to glucose abs from food + drink

Question 9

What is the first line treatment of T1DM?

Answer 9

• LA: TD detemir OR OD glargine

- RA: before meal

Question 10

What is hypoglycaemia?

Answer 10

Blood glucose levels fall < 3.5mmol/L

• Hunger
• Anxiety
• Sweating
• Tingly lips

Question 11

What are the management of hypoglycaemia?

Answer 11

• 10-20g fast acting carb:
• Recheck blood glucose after 10-15 mins: no response = repeat after another 15mins
• Unconscious: IM 1mg glucagon

Question 12

Outline the sick day rules

Answer 12

• Don’t stop insulin therapy
• Inc monitoring every 1-2 hrs
• Ketone monitoring
• Maintain meal pattern
• 3L fluid