Type 1 Diabetes

Question 1

list Clinical features of newly diagnosed Type 1 diabetes

Answer 1

• Short history (weeks) of severe symptoms
• Moderate or large urinary ketones
• Weight loss

Question 2

what is the commonist age for type 1 diabetes diagnosis

Answer 2

5-15

Question 3

if a mother has T1Diabetes , the risk of developing it is about _%

Answer 3

2

Question 4

If a father has T1Diabetes, the risk of developing it is about _%

Answer 4

8

Question 5

if both parents have T1Diabetes, the risk of developing it is up to __%

Answer 5

30

Question 6

if a brother or sister develops T1D , the risk of developing it is __%

Answer 6

10

Question 7

Offspring of affected ____ are more unwell than those of affected ____, with longer duration of symptoms, more than twice as likely to present in ketoacidosis.

Answer 7

Fathers
Mothers

Question 8

Reduced insulin leads to ___ breakdown and formation of ______ (a gluconeogenic precursor) and free fatty acids (ffa)

Answer 8

• Fat
• Glycerol

Question 9

Free fatty acids (FFA)

• Impair ________ uptake
• Are transported to the ____, providing ‘energy’ for gluconeogensis
• Are oxidised to form _____ bodies (beta hydroxy butyrate, acetoacetate and acetone)

Answer 9

• glucose
• liver
• ketone

Question 10

what is Ketoacidosis

Answer 10

• Absence of insulin + rising counterregulatory hormones cause hyperglycaemia and rising ketones
• Glucose and ketones escape in the urine but lead to osmotic diuresis and falling circulating blood vol
• Ketones cause anorexia and vomiting
• Vicious circle of increasing dehydration, hyperglycaemia and increasing acidosis eventually lead to circulatory collapse and death

Question 11

Define diabetic ketoacidosis (DKA)

Answer 11

• Hyperglycaemia (plasma glucose usually <50 mmol/l)
• Raised plasma ketones (urine ketones > 2+)
• Metabolic acidosis – plasma bicarbonate < 15 mmol/l

Question 12

What are the causes of DKA

Answer 12

• Intercurrent illness
• infection
  -myocardial infarct
• Treatment errors – stop/reduce insulin dose
• undiagnosed diabetes

Question 13

What are the clinical features of DKA

Answer 13

Symptoms:

• polyuria and polydipsia
• nausea and vomiting
• weight loss
• weakness
• abdominal pain
• Drowsiness / confusion

Signs:

• hyperventilation (Kussmaul breathing)
• dehydration
• hypotension
• Tachycardia
• coma

Question 14

How do you manage DKA

Answer 14

• Rehydration
• insulin
• replace electrolytes (k)
• treatment without delay

Question 15

what are the complications of DKA

Answer 15

• cerebral
• adult respiratory distress syndrome
• thromboembolism – venous and arterial
• aspiration pneumonia (in drowsy/comatose patients)
• death