Type 1 Diabetes Mellitus

This is where there's autoimmune destruction of pancreatic b-cells, resulting in little/no Insulin production → Hyperglycaemia.

Presentation

• 25-50% present with DKA

• Classic triad of symptoms in hyperglycaemia:

  • 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 of management here is Insulin!

• Basal-bolus regime - Long-acting given once a day, and Short-acting given 30 minutes before meals

• Insulin pump is another option – Insulin infused subcutaneously with the cannula replaced every 2-3 days

It's important to tell patients to regularly change the area that they inject the insulin in order to prevent Lipodystrophy. This is where there's hardening of the skin and fat, which makes the absorption of insulin less effective in that area.

Aside from insulin, it's important for patients to:

• Monitor their dietary carbohydrate intake

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

• Monitor for any complications e.g. blood tests, eye-tests, foot check

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