T1DM

Question 1

Aetiology

Answer 1

AI destruction of beta cells in islets of langerhans of the pancreas. Insulin deficient.
Often presents in teens after viral infection.
Usually starts young. HLA D3/4 linked.

Question 2

Symptoms

Answer 2

Polyuria
Polydipsia
Glycosuria
Weight loss
Fatigue
Visual blurring
Genital thrush
Ketosis if very bad

Question 3

Complications

Answer 3

DKA- switch to burning fat whch produces acidic ketone bodies (acetoacetate, beta hydroxybutyrate) via lyase and HMG coA reductase. Vomiting, dehydration, tachypnoea, confusion, coma. Treat with fluids and electrolytes. Insulin once K corrected. Triggered by infection, MI, stroke, cocaine, missed dose, alcohol.
Vascular effects even if mildly raised LT.
Macrovascular- atheroma, stroke, MI, renovascular disease, limb ischaemia.
Micro- retinopathy, nephropathy, neuropathy, impotence.

Question 4

Diagnosis

Answer 4

2 of:
Random glucose over 11.1 mmol/L
Fasting over 7
HbA1c over 6.5%- is glycosylation of terminal vabline of Hb, measures glucose over last 3 months. 
Normal is 7.8, 6.1, 6.

Question 5

Management

Answer 5

Long term insulin with bm monitoring.
Rapid acting bolus with meals.
Long acting for baseline control and overnight.
Adjust with exercise, calorie intake and according to fingerprick glucose.

Question 6

Differential

Answer 6

T2DM
Chronic pancreatitis
Renal glycosuria 
Peripheral neuropathy from alcoholism
Endocrine tumour producing GH, GCs, glucagon
Addisons
Hashimotos

Question 7

Subcutaneous insulins

Answer 7

-ultra fast eg humalog, novorapid.
-short acting eg humulin S
-intermediate acting eg isophane insulin.
-pre mixed with ultra fast component eg novomix.
-long acting recombinant human insulin analogues eg glargine.
-very long acting eg degludec.
AE- weigth gain, hyper/hypoglycaemia, lipodystrophy at injection site, pain on injection, allergy to preservative.

Question 8

Insulin regimens

Answer 8

Vary injection site

• BD biphasic regimen- 2x per day premixed by pen.
• QDS- ultra fast before meals, bed time long acting.
• once daily before bed long acting.

Question 9

Explanation

Answer 9

• when we eat food it gets broken down into sugar which is then absorbed into our blood. This is then used by cells in our body for energy. In order for them to use it they must take up the sugar from the blood, this requires a hormone called insulin. In T1DM your pancreas which usually makes insulin is not making enough so the sugar is staying in the blood where the cells cant use it.
• it is a genetic condition which usually presents in young people. Often triggered by viral infection but can just come on for an unknown reason.
• lifestyle involves not smoking or drinking. Eating healthily is main thing. Avoiding sugary and fatty foods. And being careful about exercise and timing of eating with injections. It is also important to monitor the level of sugar in your blood regularly. Need to be aware of when feel a hypo coming on as they can be very dangerous.
• tx will be insulin injections that you will need to have for the rest of your life. It is very important to take it properly as high blood sugar over time can increase the risk of heart problems, nerve problems and eye problems.