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Type 1 Diabetes Meillitus

In Type 1 Diabetes Meillitus, there's autoimmune destruction of pancreatic B-cells, resulting in little/no Insulin production. This leads to hyperglycaemia. 25-50% of patients present with DKA (diabetic ketoacidosis), which has a classic triad of hyperglycaemic symptoms:

  • Polyuria (due to osmotic diuresis)

  • Polydipsia (due to dehydration)

  • Weight loss (due to catabolism)


Investigations

  • Exclude other associated pathologies

  • Bloods - FBC, U&E, HbA1c, Glucose, TFTs, Anti-TTG


Management

The mainstay here is Insulin, which involves:

  • Long-acting given once a day

  • Short-acting given 30 minutes before meals

This is typically given as an injection, but another option is an insulin pump, which infuses the medication subcutaneously (cannula has to be replaced every 2-3 days)


It's important for patients to vary the place at which they inject as it can lead to Lipodystrophy if frequently injected into the same spot.


Other areas of management:

  • Monitoring dietary carbohydrate intake

  • Monitoring blood sugar levels on waking, at each meal and before bed

  • Monitoring and managing complications


Complications

Short-term

  • Hypoglycaemia

  • DKA


Long-term

  • Microvascular – Neuropathy, Retinopathy, Nephropathy (particularly glomerulosclerosis)

  • Macrovascular – Coronary artery disease, Peripheral ischaemia (Poor healing, ulcers, diabetic foot), Stroke, HTN



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