Diabetes L2: Disease Development, Insulin Types, Diabetes Fatigue

What happens in Type 1 diabetes?

Autoimmune destruction of pancreatic beta cells leading to reduced beta cell mass and insulin deficiency; involves insulitis and beta cell injury; genetic predisposition contributes.

What is the role of beta cell mass in Type 1 diabetes development?

Loss of beta cell mass over time reduces insulin production, contributing to progression from pre-diabetes to overt diabetes.

What does genetic predisposition refer to in Type 1 diabetes?

Genetic factors (such as HLA/MHC alleles) increase the risk of autoimmune beta-cell destruction.

What is insulitis?

Inflammatory infiltration of pancreatic islets by immune cells leading to beta-cell injury and death.

Name some factors implicated in the development of Type 1 diabetes.

Fas ligand/cytokines, enteroviruses, free radicals, diet, low beta-cell defences, vaccination, viral infections, islet cell-cell contact, nervous system interactions (neuropeptides), genetics, vitamin D, hygiene hypothesis, lymph node interactions, NOD mouse models, and combinations of factors.

What is pre-diabetes in the Type 1 diabetes pathway?

A stage before overt diabetes with partial beta-cell loss and impaired insulin response.

What is the sequence of development for Type 1 diabetes as described in the notes?

"Pre-diabetes" → "Newly Diagnosed Diabetes" → "Diabetes".

What is the standard insulin concentration in the UK?

100 IU/mL.

How is human insulin produced?

Genetically engineered in yeast or E. coli.

Name common insulin regimens used in Type 1 diabetes management.

Once daily regimen (mixture of long- and short-acting analogues), Twice daily regimens (mixture of short and long-acting), Multiple daily injections (basal-bolus with short-acting before meals and one daily long-acting), Insulin pump (short-acting insulin only).

What are the main categories of insulin by duration of action?

Short-acting (lispro, aspart, glulisine, novorapid), Intermediate (NPH/isophane), Long-acting (glargine, detemir; also brands like Lantus, Levimir).

Which insulin analogue has the longest duration of action?

Glargine (Lantus).

What is a basal-bolus insulin regimen?

Long-acting insulin provides basal coverage while short-acting insulin is taken with meals to cover carbohydrate intake (bolus).

How is carbohydrate intake linked to insulin dosing in this case?

10 g of carbohydrate equals 1 unit of insulin (1 carbohydrate portion equals 1 unit of insulin).

If a meal has 51 g of carbs, how many carbohydrate portions (CP) are there?

5 CPs (51 g ÷ 10 g per CP = 5.1, typically rounded to 5 CPs).

What factors are read on food labels for carbohydrate counting?

Total carbohydrate (not just sugars), portion/serving size, whether the food is raw or cooked, and glycaemic index.

What is a major challenge in self-care for young people with Type 1 diabetes?

Achieving optimal glycaemic control (blood glucose 4–11 mmol/L, HbA1c < 48 mmol/mol).

What is the NHS Best Practice Tariff (BPT) in transitional care?

A funding framework that sets high standards for transitional care; providers are paid only if their service meets standards and includes a transitional care policy for handing over to adult services.

What are key components of good transitional care?

Flexible care teams, individualized care, involvement of family, overlap between paediatric and adult teams, and a process-driven transition rather than a one-off event.

What is 'diabetes burnout' and how can the health care team help?

A psychological state where young people become disengaged from diabetes management; support includes addressing mental health, providing SEP (structured education programme), regular follow-up, and empathetic care.

In a Case 3 MCQ, which insulin analogue has the longest duration of action?

Glargine (Lantus) as the longest-acting analogue among the options.

What is considered a healthy HbA1c range?

6.5% and below.

What are the two units used to measure HbA1c?

Percentage (old unit) or mmol/mol (new units).

What is the target HbA1c level in mmol/mol, equivalent to 6.5%?

48 mmol/mol.

What is the primary characteristic of an islet from a patient with Type 1 Diabetes?

There are no insulin producing (beta) cells, as they have been destroyed by the patient's immune system.

What percentage of the pancreas do the islets make up?

5%.

In Type 1 Diabetes, what does the immune system specifically target and destroy?

The insulin-producing beta cells only.

Which stage of the Eisen Boff Model involves genetic predisposition but 100% beta-cell mass?

Stage 1.

What is 'insulitis' in the context of Type 1 Diabetes development?

An inflammation in the islets and insulin producing cells.

At what stage of Type 1 Diabetes development is half of the beta-cell mass already lost, and patients may start to feel symptoms?

Stage 3 (Pre-diabetes).

At what stage are most Type 1 Diabetes patients diagnosed, with less than 10% of normal beta-cell mass remaining?

Stage 4 (Diabetic).

Is pancreatic neogenesis (formation of new beta cells) still possible in Type 1 diabetics?

Yes, the pancreas continues to try and create insulin producing cells.

What is the standard concentration of all insulin in the UK?

100iu/ml.

How is human insulin genetically engineered for medical use?

Using yeast or E.coli.

Which insulin administration regime aims to get newly diagnosed patients to manage insulin levels before meals and one daily injection of long-acting insulin?

Multiple daily injections (Basal Bolus).

Which type of insulin is used exclusively with insulin pumps?

Short-acting insulin.

Name three examples of rapid-acting insulins.

Lispro, Aspart, Glulisine.

Name two examples of long-acting insulins.

Glargine, Deter (also Lantus, Levemir).

Approximately how many grams of carbohydrates generally require 1 unit of insulin for a newly diabetic patient?

10g (or 1 carbohydrate portion, CP).

What are two important aspects to check when reading food labels for diabetes management?

Portion/serving sizes and total carbohydrate content (not just 'of which sugars').

What does a high glycemic index indicate about a food's effect on blood glucose?

Digestion occurs quickly, and it affects blood glucose levels quickly.

What consequence of Type 2 Diabetes can indicate uncontrolled blood glucose?

Erectile Dysfunction.

What is 'transition' in the context of diabetes care?

The movement of an adolescent from paediatric to adult diabetes care services (typically between 17-19 years).

Why is the transition period considered a 'High Risk Time' for young people with diabetes?

Parents may feel left out, and the young person may feel anonymous or unimportant to the new adult care team, combined with the difficulty of self-care during teenage years and increased independence.

What is offered to all patients to mitigate self-neglect during the transition period?

A structured education programme (SEP).

According to NHS 'Best Practice Tariff,' what are providers required to have for young diabetic patients up to 19 years?

A Transitional Care Policy, ensuring a gradual, individualized, and collaborative handover to adult services.

Name two characteristics of good transition care for young people with diabetes.

A flexible care team, individualized care (handoff only when self-care autonomy is achieved up to age 19), involvement of family/carers, overlapping paediatric and adult teams, and a process that works through the entire transition as it is not a one-off event.