Endocrinology

Question 1

What viruses may trigger Type 1 Diabetes?

Answer 1

• Cocksackie B virus

- Enterovirus

Question 2

Outline what Type 1 Diabetes is?

Answer 2

Type 1 Diabetes is an auto-immune condition involving destruction of the beta-cells in the Islets of Langerhan of the Pancreas

Question 3

What is the clinical presentation of Type 1 Diabetes?

Answer 3

• Diabetic Ketoacidosis
• Hyperglycaemia triad (polyuria, polydypsia, weight loss)
• Secondary enuresis
• Recurrent infections

Question 4

What are the clinical features of Diabetic Ketoacidosis?

Answer 4

• Abdominal pain
• Polyuria, polydypsia, dehydration
• Kaussmaul breathing
• Acetone “pear drops” breath

Question 5

What blood tests results help diagnose Diabetic Ketoacidosis?

Answer 5

• Glucose >11mmol / known diabetic
• pH < 7.3
• Bicarbonate < 15 mmol
• Ketones > 3
• Urine ketones ++

Question 6

What are new diagnosis bloods to be ordered in someone with Type 1 Diabetes?

Answer 6

• Baseline bloods (FBC, Renal Profile, U&Es)
• Blood cultures (If ?infection)
• HbA1c
• TFTs, TPO (thyroid peroxidase antibodies)
• Anti-TTG (associated with Coeliacs)
• Insulin antibiotics, anti-GAD, Islet cell antibodies

Question 7

How is Diabetic Ketoacidosis managed?

Answer 7

• Fluid management, 5-8 litres (isotonic saline initially)
• Insulin, initially 0.1 units / kg / hr, once glucose <15 mmol then 5% dextrose
• Correction of hypokalaemia
• Continue long acting insulin, stop short acting insulin

Question 8

What are the normal levels for glucose during the day?

Answer 8

5-7 mmol on waking

4-7 mmol other times of day

Question 9

How often should blood glucose levels be checked?

Answer 9

On waking, at each meal and before bed (at least 4 times a day)