Type 1 Diabetes

Question 1

What is diabetes mellitus?

Answer 1

A chronic condition of hyperglycaemia caused by absolute or relative insulin deficiency.

Question 2

What are the cardinal symptoms of diabetes?

Answer 2

Thirst (polydipsia), polyuria, and weight loss.

Question 3

How many people worldwide had diabetes as of 2004 (WHO)?

Answer 3

> 150 million.

Question 4

What proportion of diabetes cases are Type 1?

Answer 4

About 20%.

Question 5

What are the two subtypes of Type 1 diabetes?

Answer 5

• Type 1A: Autoimmune
• Type 1B: Idiopathic (no autoimmunity).

Question 6

What is the hallmark of Type 1 diabetes?

Answer 6

Absolute insulin deficiency.

Question 7

What autoantibodies are associated with autoimmune Type 1 diabetes?

Answer 7

Islet Cell Antibodies (ICA) and Anti-GAD antibodies.

Question 8

What causes hyperglycaemia in Type 1 diabetes?

Answer 8

Destruction of pancreatic β-cells → loss of insulin secretion.

Question 9

What are typical features of Type 1 diabetes?

Answer 9

Abrupt onset, ketosis-prone, requires insulin, autoimmune associations.

Question 10

Name autoimmune diseases associated with Type 1 diabetes.

Answer 10

Addison’s disease, hypothyroidism, pernicious anaemia.

Question 11

What NICE guideline covers children and young adults with diabetes?

Answer 11

NICE NG18.

Question 12

What NICE guideline covers adults with Type 1 diabetes?

Answer 12

NICE NG17.

Question 13

What is the model of care for diabetes management?

Answer 13

Multidisciplinary team involving primary and secondary care.

Question 14

Who are key members of the diabetes care team?

Answer 14

• GP
• DSN
• dietitian
• podiatrist
• retinal screening team
• diabetes consultant

Question 15

Who is usually the patient’s main contact in secondary care?

Answer 15

Diabetes Specialist Nurse (DSN).

Question 16

What are the initial steps when diagnosing new diabetes?

Answer 16

Confirm diabetes (BG criteria), exclude pregnancy, and assess symptoms.

Question 17

What is the first test for glycosuria or ketones?

Answer 17

Urine dipstick for glucose and ketones.

Question 18

What level of ketones suggests insulin deficiency?

Answer 18

≥2+ on urine dipstick or elevated blood ketones.

Question 19

When should a patient with suspected Type 1 diabetes be admitted?

Answer 19

If vomiting, septic, or unwell — to exclude DKA.

Question 20

What are initial non-hospital steps for stable new Type 1 diabetes?

Answer 20

• Refer to DSN urgently
• Begin insulin education
• Provide monitoring equipment and support.

Question 21

What should be arranged soon after diagnosis?

Answer 21

Dietitian review (with family participation encouraged).

Question 22

What is the general goal of insulin therapy?

Answer 22

To mimic physiological insulin secretion (basal + bolus).

Question 23

What is a typical starting dose for premixed insulin?

Answer 23

10 units AM and 6 units PM (30/70 mix before meals).

Question 24

What is a basal-bolus (BBR) regimen?

Answer 24

50% long-acting insulin + 50% short-acting divided before meals.

Question 25

What training is provided before insulin use?

Answer 25

DSN education with dummy injections using sterile water.

Question 26

What should patients be taught early?

Answer 26

Blood glucose monitoring, recognition of hypoglycaemia, driving advice, and contact points for support.

Question 27

What are the DVLA rules for patients with Type 1 diabetes?

Answer 27

Must inform DVLA and insurance provider.

Question 28

When should patients with uncontrolled diabetes be admitted?

Answer 28

If BG high + ketones + vomiting or sepsis.

Question 29

What checks should be done before assuming insulin failure?

Answer 29

- Insulin expiry and storage - Injection technique and sites - Device functioning.

Question 30

What common causes may temporarily raise blood glucose?

Answer 30

Infection or corticosteroid use.

Question 31

How should insulin be adjusted during illness or steroids?

Answer 31

- Increase by 2–4 units daily until BG stabilises - reduce when improving.

Question 32

How does injected insulin behave under the skin?

Answer 32

Forms hexamers that break down into dimers/monomers before absorption.

Question 33

What determines insulin’s duration of action?

Answer 33

Stability of the hexamer (more stable = slower action).

Question 34

How are insulin formulations modified to alter absorption?

Answer 34

Add protamine, zinc, or genetic alterations for stability.

Question 35

What is short-acting insulin also called?

Answer 35

Soluble or regular insulin.

Question 36

When should short-acting insulin be injected?

Answer 36

30 minutes before meals.

Question 37

What is its onset, peak, and duration?

Answer 37

- Onset 30 mins - peak 1–3 hrs - duration 4–8 hrs.

Question 38

What is delayed-action insulins onset and duration?

Answer 38

- Onset 1–2 hrs - peak 4–12 hrs - duration up to 24 hrs.

Question 39

What are examples of delayed-action insulins?

Answer 39

Isophane (NPH), Lente (protamine/zinc suspension).

Question 40

What is the usual biphasic insulin mix?

Answer 40

30% short-acting + 70% intermediate.

Question 41

Who discovered insulin and when?

Answer 41

Banting and Best, 1921–1922.

Question 42

When did human insulin replace animal insulin?

Answer 42

1980s (via recombinant DNA technology).

Question 43

What are examples of rapid-acting insulin analogues?

Answer 43

Novorapid, Humalog.

Question 44

What are examples of long-acting insulin analogues?

Answer 44

Glargine, Detemir.

Question 45

What is the duration of action of long-acting analogues?

Answer 45

20–22 hours.

Question 46

What is continuous subcutaneous insulin infusion (CSII)?

Answer 46

Pump delivering adjustable basal insulin + meal-time boluses.

Question 47

What are pros and cons of CSII?

Answer 47

Closely mimics physiology but requires training, motivation, and is costly.

Question 48

What is the general carbohydrate-to-insulin ratio?

Answer 48

10 g carbohydrate = 1 unit of insulin.

Question 49

Recommended macronutrient distribution?

Answer 49

60% carbs, <30% fat, ≥0.8 g/kg protein.

Question 50

How much exercise should be recommended?

Answer 50

≥30 minutes brisk walking, 5 times/week.

Question 51

Who should deliver diet education?

Answer 51

Dietitian (reinforced by DSN).

Question 52

What is the initial management of an unconscious diabetic?

Answer 52

ABCD approach, recovery position, check capillary BG, IV access, send bloods, check ABG.

Question 53

What blood glucose defines hypoglycaemia?

Answer 53

<4.0 mmol/L.

Question 54

How is mild hypoglycaemia treated (if conscious)?

Answer 54

- 5 Dextrosol tablets or - 3 tsp sugar/glucose in water or - 150 ml Lucozade/juice, then starchy snack.

Question 55

How is hypoglycaemia treated if unconscious?

Answer 55

- 100 ml 20% glucose IV (or 200 ml 10%) over 15 mins - If IV access delayed → 1 mg IM glucagon. - Recheck BG in 10 min; repeat if <4 mmol/L.

Question 56

What should follow once the patient recovers from being unconscious?

Answer 56

Oral glucose and starchy food.

Question 57

What is DKA?

Answer 57

Severe uncontrolled diabetes with hyperglycaemia, ketonaemia, and acidosis due to insulin deficiency.

Question 58

Common precipitants of DKA?

Answer 58

Infection, missed insulin, or undiagnosed new diabetes.

Question 59

What are typical symptoms of DKA?

Answer 59

Nausea, vomiting, dehydration, hypotension, hyperventilation.

Question 60

What is the mainstay of DKA management?

Answer 60

IV fluids, IV insulin, electrolyte correction, and addressing the cause.

Question 61

What is the target HbA1c?

Answer 61

<53 mmol/mol.

Question 62

What is the BP target?

Answer 62

<135/85 (or <130/80 if microalbuminuria present).

Question 63

When should aspirin and statins be started?

Answer 63

- Aspirin if >40 years + ≥1 CV risk factor. - Atorvastatin 20 mg if >40 years, nephropathy, or other CV risk.

Question 64

Name 3 microvascular complications.

Answer 64

Retinopathy, nephropathy, neuropathy.

Question 65

Name 3 macrovascular complications.

Answer 65

Peripheral vascular disease, coronary heart disease, cerebrovascular disease.