Diabetes Type 1 Diabetes 4 — Questions and Answers
Question 1: A teenager with Type 1 diabetes has a blood glucose of 400 mg/dL with large ketones but no vomiting. What is the most appropriate initial management?
- Immediate IV fluid resuscitation in hospital
- Extra bolus of rapid-acting insulin and increased fluid intake at home (Correct answer)
- Glucagon administration
- Skip next insulin dose to avoid stacking
Correct answer: Extra bolus of rapid-acting insulin and increased fluid intake at home
For sick-day management without vomiting, supplemental rapid-acting insulin plus oral hydration is appropriate; hospital care is needed if vomiting or severe symptoms develop.
Question 2: Which pancreatic cell type is specifically destroyed in Type 1 diabetes?
- Alpha cells (glucagon-producing)
- Beta cells (insulin-producing) (Correct answer)
- Delta cells (somatostatin-producing)
- PP cells (pancreatic polypeptide-producing)
Correct answer: Beta cells (insulin-producing)
Type 1 diabetes results from autoimmune destruction of insulin-secreting beta cells in the islets of Langerhans, leading to absolute insulin deficiency.
Question 3: What does the 'insulin sensitivity factor' (correction factor) represent in Type 1 diabetes?
- The number of carbs covered by one unit of insulin
- How many mg/dL one unit of insulin will lower blood glucose (Correct answer)
- The maximum safe dose of insulin per day
- The ratio of basal to bolus insulin required
Correct answer: How many mg/dL one unit of insulin will lower blood glucose
The insulin sensitivity factor (e.g., 1 unit lowers glucose by 50 mg/dL) is used to calculate correction doses when blood glucose is above target.
Question 4: Which pattern of blood glucose readings suggests the dawn phenomenon rather than the Somogyi effect?
- Nighttime low followed by morning high
- Steady rise in glucose from ~3 AM without preceding hypoglycemia (Correct answer)
- Random spikes throughout the night
- Consistent morning hypoglycemia
Correct answer: Steady rise in glucose from ~3 AM without preceding hypoglycemia
The dawn phenomenon is a morning hyperglycemia caused by counter-regulatory hormone surges (growth hormone, cortisol) in the early morning without preceding nocturnal hypoglycemia.
Question 5: What is the significance of C-peptide measurement in a patient suspected of having Type 1 diabetes?
- It measures insulin antibody levels
- Low or absent C-peptide confirms minimal endogenous insulin production (Correct answer)
- It determines insulin resistance
- It measures glucagon levels indirectly
Correct answer: Low or absent C-peptide confirms minimal endogenous insulin production
C-peptide is co-secreted with insulin in equal amounts; low or undetectable C-peptide confirms absent endogenous insulin production consistent with Type 1 diabetes.
Question 6: Which eye complication requires urgent ophthalmology referral in a patient with Type 1 diabetes?
- Background retinopathy with microaneurysms only
- Proliferative diabetic retinopathy (Correct answer)
- Mild non-proliferative retinopathy
- Blurry vision due to glucose fluctuation
Correct answer: Proliferative diabetic retinopathy
Proliferative diabetic retinopathy involves new blood vessel formation (neovascularization) that can cause vitreous hemorrhage and retinal detachment, requiring urgent treatment.
Question 7: A patient with Type 1 diabetes is unconscious from hypoglycemia and cannot swallow. What is the correct treatment?
- Force oral glucose gel
- Administer 1 mg glucagon IM or intranasal glucagon (Correct answer)
- Wait for spontaneous recovery
- Give oral orange juice slowly
Correct answer: Administer 1 mg glucagon IM or intranasal glucagon
For an unconscious hypoglycemic patient who cannot swallow, intramuscular or intranasal glucagon is the appropriate prehospital treatment to raise blood glucose.
Diabetes Type 1 Diabetes 4
A teenager with Type 1 diabetes has a blood glucose of 400 mg/dL with large ketones but no vomiting.
What is the most appropriate initial management?