Type 1 Diabetes Mellitus

Front 1

Questions on a diabetes history?

Back 1

Autonomic complications
Microvascular complications: nephropathy, retinopathy, neuropathy.
Macrovascular complications: CVS, CVD, PVD
Family history
Treatment
Compliance
Hospital admissions
Specialist appointments

Front 2

Autonomic complications of diabetes?

Back 2

Erectile dysfunction.
Gastroparesis - do you feel full easily after a meal? do you vomit?
Have you had any formal imaging for gastro?
Postural hypotension - when you stand up do you feel dizzy or unwell?

Front 3

What infections are particularly common in girls with type 1 diabetes?

Back 3

Thrush (vaginal candidiasis)

Front 4

What is the pathogenesis of type 1a?

Back 4

Autoimmune destruction of the insulin producing beta cells.

Front 5

What is the pathogeneiss of type 1b?

Back 5

Non autoimmune.

Front 6

What are some of the factors in the causation of type 1 dibaetes?

Back 6

Closely associated with HLA genes.
Lifelong risk of type 1 dibaetes is increased in close relatives of a patient with type 1 symptoms.

Front 7

What environmental factors are linked in the causation of type 1 diabetes?

Back 7

Perinatal: increased birth weight, maternal age.
Viruses
Diet: cow's milk and cereal at early age thought to be implicated.

Front 8

What autoimmune disorders are associated with type 1 diabetes?

Back 8

Hypothyroidism
Coeliac disease
Addison's
Vitiligo
Autoimmune polyglandular syndromes
Pernicious anaemia

Front 9

What is the fasting plasma glucose to diagnose diabetes?

Back 9

> 7.0 mmol/L

Front 10

(a) Outline the principles of gamma radiography.

Back 10

Gamma radiography uses the transmission of gamma rays from a sealed ionising radiation source through a test object on to a film placed on the opposite side. The film records the intensity of the radiation received and since cracks and flaws are hollow, a greater intensity of rays pass onto the film and the defects are shown up as darker regions.

Front 11

What is the random plasma glucose needed to diagnose diabetes?

Back 11

11.1 mmol/L

Front 12

What is an additional test to help diagnose type 1 diabetes?

Back 12

Islet cell antibodies
GAD
Insulin antibodies

Front 13

What other investigations should be done in a suspected type one DM?

Back 13

C-peptide (low in type 1)
Insulin levels

Front 14

What is impaired fasting glucose?

Back 14

5.6 - 6.9

Front 15

What is impaired glucose tolerance?

Back 15

7.8 - 11.0

Front 16

What HbA1c would diagnose diabetes?

Back 16

< 6.5%

Front 17

What is HbA1c?

Back 17

Glycated haemoglobin. Gives an idea of the average blood sugar of last 3 months.

Front 18

How can anaemia skew the HbA1c?

Back 18

It can make it falsely low.

Front 19

Name all the common symptoms of diabetes.

Back 19

Polyuria
Polydipsia
Weight loss
Infection
Visual blurring
DKA
Hyperosmolar hyperglycaemia state
Asymptomatic

Front 20

Which type is HHS more commonly seen in?

Back 20

Type II more so than type I.

Front 21

Which type is more likely to have ketoacidosis?

Back 21

Type I diabetes.

Front 22

What are some features of non-proliferative retinopathy?

Back 22

Blot haemorrhages
Microaneurysms
Cotton wool spots

Front 23

What is the problem with proliferative nephropathy?

Back 23

Proliferative - new unstable blood vessels can develop so need to laser blood vessels.

Front 24

What is the concern with diabetic nephropathy?

Back 24

Can lead to renal failure and diiabetic nephropathy.

Front 25

Risk factors to develop nephropathy in a diabeic?

Back 25

Famiily history
Smoking
Hypertension
Poor glycaemic control

Front 26

Which medications are good to treat nephropathy?

Back 26

ACE-Inhibitor
or
ARB

Front 27

What causes neuropathy?

Back 27

Microvascular disease affecting the small nurtient vessels that supply peripheral nerves.

Front 28

What is the first-line for diabetic pain?

Back 28

Amytryptilline
GaBA pentin
Sodium valproate

Front 29

What investigations should you do in a DKA?

Back 29

Blood gasses
BSL
Ketones
FBE
UEC

Consider
LFT
Lipase
CRP
Blood cultures
CXR/AXR

Front 30

Why might lipase be raised in DKA?

Back 30

Not diagnostic of pancreatitis.
It is just raised sometimes.

Front 31

When do you cease an insulin infusion in a DKA patient?

Back 31

Ketones going down
pH going up

Front 32

When is dextrose started with the insulin infusion in a diabetic patient?

Back 32

When BSL < 15 can give 10% dextrose.

Front 33

What is the problem with potassium when giving insulin to a DKA?

Back 33

giving insulin can drive potassium into the cell

Front 34

What are the three components to DKA?

Back 34

Anion gap acidosis
Hyperglycaemia
Ketoacidosis

Front 35

How is the anion gap calculated?

Back 35

Na - (Hco3 + Cl)

Front 36

How do you get DKA?

Back 36

Breakdown of adipose tissue
Causes free fatty acids
Converted in the liver into ketone bodies
The hyperglycaemia causes dehydration because of osmotic diuresis.

Front 37

What are the clinical features of DKA?

Back 37

Polyuria
Weight loss
blurred vision
n + v
abdominal pain
hyperventilation
confusion

Front 38

What are precipitating factors for DKA?

Back 38

Infection (pneumonia or UTI)
discontinuation or inadequate insulin therapy
acute major illnesses such as MI
new onset type I
poor compliance with insulin
malfunction of insulin pump

Front 39

How to treat DKA?

Back 39

Fluid replacement (normal saline)
IV insulin
measure serum glucose hourly until stable
if initial serum potassium below 3.3 mmol/L make sure you give aggressive fluid and potassium replacement prior to treatment with insulin

Front 40

What are the features of hyperosmolar hyperglycaemic state?

Back 40

Elderly patients
Develops gradually
Usually not acidotic or ketotic
Profoundly dehydration, hypotension, tachycardia, altered mental status
Marked hyperglycaemia, hyperosmolality
Volume depletion and hyperglycaemia are the main features
Treatment is via volume replacement and insulin therapy

Front 41

What is lantus?

Back 41

Recombinant human insulin analogue
Basal long-acting insulin
Usually once-daily subcut, but often BD.
usually given in morning or night

Front 42

What is detemir? (levemir)

Back 42

Basal long acting insulin
twice daily subcut
peaks 3 - 14 hours, duration up to 24 hours
only approved for type 1 diabetes

Front 43

What are the benefits of CSII?

Back 43

Flexibility
Better control
Less injections
Cost
- only available for type 1 diabetes with private health insurance
- 8000 to 10000 dollars for a pump

Front 44

What is DAFNE?

Back 44

Diet
Adjusted
For
Normal
Eating

- Run by diabetic educators to calculate how much insulin is needed for how many grams of carbohydrates.

Front 45

Where are common injection sites?

Back 45

Subcutaneous: buttocks, abdomen, upper thigh, arm.

Front 46

What can repeated insulin injections cause?

Back 46

Lipohypertrophy.
Patients like it because it is painless but very little insulin is absorbed.