Diabetes Mellitus Type 1
Risk of T1DM
0.4% prevalence
3% if mum has it
5% if non twin sib has
6% if dad has
8% if DZ twin has (?? uterine enviroment inc beyond non twin sib)
30% if
50% if MZ twin has
Ix
Ketoacidosis
Ur/Cr > ARF
GAD antibodies (glutamic acid decarboxylase) (70% of T1DM)
Rx
Monitor neuro status (Cerebral oedema)
Monitor BSL (hypoglycemia)
Insulin
~1U/kg/day total, less in young children
Aim for HbA1C of <7.5 correlates with average BSL <9.4
Premeal and prebed BSLs ie min 4
Aim 4-6
<4 = hypo
Care with hyperglycaemia without ketosis > more likely to go low as ketosis confers a degree of insulin resistance
When adjusting insulin post hypo look at
- time of the hypo
- link back to which insulin is having the most effect at that time
Hypoglycemia (to much insulin, not enough food)
- adrenergic symptoms: Tremor, pallor, rapid heart rate, palpitations, and diaphoresis)
- Neuroglycopenic symptoms: Fatigue, lethargy, headaches, behaviour changes, drowsiness, unconsciousness, seizures, or coma.
NB blunting autonomic adrenaline response ie lower set point for adrenaline release in T1DM due to recurrent hypos leads to hypoglycemia unawareness.
Macrovascular
- Cardiovasc
Microvascular
- Nephropathy (check for urine alb)
- Retinopathy (ophthal)
- Neuropathy
Counsel:
OH suppresses hepatic gluconeogenesis
Limited glucagon response and glycogen stores in T1
Prognosis
DKA
- Death (60% of DKA deaths are cerebral oedema)
Hypo
Suicide
Compl
Thyroid antibodies (20%) > 2-5% of T1DM get hypothyroidism
Coeliac (5%)
21 hydroxy antibodies in 2% > ½ or ~1% get addisons