T1DM

• What is T1DM?


  Autoimmune condition

  Characterised by destruction of beta cells within islets of Langerhans in pancreas -> insulin deficiency
• Pathophys - T1DM


  Body cannot make enough insulin → type IV hypersensitivity → T cells attack pancreas

  Genetic abnormality → loss of self-tolerance in T cells that have strong affinity for beta cells in pancreas → T cell immune response against beta cells in pancreas → beta cell death → less beta cells = less insulin secretion → increase glucose in blood

  Even though lots of glucose within the blood, cannot enter cells → cells starved for energy → adipose tissue begins to breakdown fat (lipolysis) & muscle tissue begins to breakdown proteins → weight loss (in uncontrolled diabetes)
• What is the normal range of BM?


  4-6 mmol/L (fasting)

  4-11 mmol/L (non-fasting)
• What are the RFs of T1DM?


  FHx

  Early life exposure to enteroviruses

  Low vitamin D diet
• What is the peak incidence of T1DM?


  6 months - 5 years

  During puberty
• What are the signs & symptoms of T1DM?


  Polyuria

  Polydipsia

  Weight loss (distinguishing factor between T1DM & T2DM)

  Pts may present with DKA

  • hyperglycaemia
  • metabolic acidosis
  • ketonaemia
• What are the DDx of T1DM?


  Diabetes insipidus

  MODY (Maturity Onset Diabetes of the Young)

  Hyperthyroidism
• What are the Inx of T1DM?


  Obs

  Full Hx & examination

  Urine ketones

  Bloods

  • FBC
  • U&Es
  • LFTs
  • CRP
  • TFTs
  • Lab glucose
  • Cultures
  • HbA1c
  • TPO antibodies
  • anti-TGG antibodies
  • insulin antibodies
  • islet cell antibodies
• What is the management of T1DM?


  Insulin therapy

  Glycaemic control

  Lifestyle interventions (nutrition, exercise, alcohol)

  Blood glucose monitoring

  Regular follow-up (monitoring glycaemic control)

  Psychosocial support

  BP control

  Monitoring for & managing complications
• What are the associations with T1DM?


  Growth & pubertal development (delay in puberty & obesity)

  Associated illnesses

  • thyroid disease (screening recommended)
  • coeliac disease
• How is insulin prescribed?


  Long acting insulin (given once a day) & short acting insulin (injected 30 mins before intake of carbs)

  Alternatively, can be administered by insulin pump
• What is the treatment for hypoglycaemia?


  Rapid acting glucose (e.g. lucozade)

  Slower acting glucose (e.g. biscuits or toast)

  If there is impaired consciousness...

  • IV dextrose
  • IM glucagone
• Apart from DM, what are the other causes of hypoglycaemia?


  Hypothyroidism

  Glycogen storage disorders

  Growth hormone deficiency

  Liver cirrhosis

  Alcohol & fatty acid oxidation defects
• How can hyperglycaemia be treated?


  Insulin
• What are the possible short-term complications of T1DM?


  Hypoglycaemia

  Hyperglycaemia
• What are the possible long-term complications of T1DM?


  CAD

  Peripheral ischaemia -> poor healing

  Stroke

  HTN

  Peripheral neuropathy

  Retinopathy

  Kidney disease (glomerulosclerosis)

  Recurrent infections (UTIs, pneumonia, skin & soft tissue infections, fungal infections)
• Why is HbA1c measured at diabetic reviews?


  Glycated haemoglobin

  Reflects the average blood glucose level over the last 3 months

  Measured every 3-6 months to track control of blood glucose
• What is the 'honeymoon period' of T1DM?


  Time where the disease has been identified & treated BUT there is still some residual insulin production as not all beta cells have been destroyed

  Pts insulin requirement may be very low

  Should be monitored closely as the child's insulin requirements will suddenly jump