Type 1 Diabetes Mellitus Questions & Answers

Updated: Sep 13, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Questions & Answers

Overview

When is screening indicated for type 1 diabetes mellitus (DM)?

What is type 1 diabetes mellitus (DM)?

What are the classic symptoms of type 1 diabetes mellitus (DM)?

What are non-classic symptoms of type 1 diabetes mellitus (DM)?

How might type 1 diabetes mellitus (DM) initially present?

What are the ADA diagnostic criteria for type 1 diabetes mellitus (DM)?

Which lab tests are performed in the diagnosis of type 1 diabetes mellitus (DM)?

How are glycemic goals established for type 1 diabetes mellitus (DM)?

How are blood glucose levels monitored in type 1 diabetes mellitus (DM)?

When is insulin therapy indicated for type 1 diabetes mellitus (DM)?

What are common insulin regimens used for the treatment of type 1 diabetes mellitus (DM)?

What is the role of diet in the treatment of type 1 diabetes mellitus (DM)?

What is the role of exercise in the treatment of type 1 diabetes mellitus (DM)?

What is type 1 diabetes mellitus (DM)?

Which age groups are at highest risk for type 1 diabetes mellitus (DM)?

How are type 1 and type 2 diabetes mellitus (DM) differentiated?

What is the approach to treatment of type 1 diabetes mellitus (DM)?

What is the medical cost of type 1 diabetes mellitus (DM) in the US?

What is the pathophysiology of type 1 diabetes mellitus (DM)?

What is the role of autoimmunity in the pathogenesis of type 1 diabetes mellitus (DM)?

Which autoimmune diseases are associated with type 1 diabetes mellitus (DM)?

What is the role of pancreatic volume in the pathogenesis of type 1 diabetes mellitus (DM)?

What are the genetic determinants of type 1 diabetes mellitus (DM)?

What is the cause of sensory and autonomic neuropathy in type 1 diabetes mellitus (DM)?

What is the association between microvascular disease and type 1 diabetes mellitus (DM)?

What is the source of renal lesions in type 1 diabetes mellitus (DM)?

What is the significance of vitamin D deficiency in type 1 diabetes mellitus (DM)?

What is the pathogenesis of nephropathy in type 1 diabetes mellitus (DM)?

What is double diabetes?

What is the significance of low estimated glucose disposal rate (eGDR) in type 1 diabetes mellitus (DM)?

What causes type 1 diabetes mellitus (DM)?

What is the sibling risk for type 1 diabetes mellitus (DM)?

What is the parent-to-child risk for type 1 diabetes mellitus (DM)?

How does the frequency of type 1 diabetes mellitus (DM) vary geographically?

Which DR-DQ haplotypes increase the risk for type 1 diabetes mellitus (DM)?

Which DR-DQ haplotypes decrease the risk for type 1 diabetes mellitus (DM)?

Which DR-DQ haplotypes confers the highest risk for type 1 diabetes mellitus (DM)?

Which ethnic groups carry high risk DR-DQ haplotypes for type 1 diabetes mellitus (DM)?

Which genes are associated with susceptibility to type 1 diabetes mellitus (DM)?

What are the nongenetic risk factors for type 1 diabetes mellitus (DM)?

What is the relationship between maternal age and the susceptibility to type 1 diabetes mellitus (DM)?

What is the association between vitamin D and type 1 diabetes mellitus (DM)?

What is the association between upper respiratory infection and type 1 diabetes mellitus (DM)?

What is the prevalence and incidence of type 1 diabetes mellitus (DM) in the US?

What is the global prevalence of type 1 diabetes mellitus (DM)?

How does the incidence of type 1 diabetes mellitus (DM) vary by age?

How does the prevalence of type 1 diabetes mellitus (DM) vary by sex?

How does the prevalence of type 1 diabetes mellitus (DM) vary by race?

What are the morbidities of type 1 diabetes mellitus (DM)?

What factors affect the long-term prognosis of type 1 diabetes mellitus (DM)?

What are complications of type 1 diabetes mellitus (DM)?

How does coronary vasodilator dysfunction affect the prognosis of type 1 diabetes mellitus (DM)?

What is the association between type 1 diabetes mellitus (DM) and small-fiber neuropathy?

What are the mortality differences between early-onset and late-onset type 1 diabetes mellitus (DM)?

Which factors are indicators of poorer prognosis in type 1 diabetes mellitus (DM)?

What is the role of patient education in the management of type 1 diabetes mellitus (DM)?

What education about type 1 diabetes mellitus (DM) should patients be given at every clinical visit?

What are the ADA recommendations for patient education of older adolescents with type 1 diabetes mellitus (DM)?

What is key information to include in patient education about type 1 diabetes mellitus (DM)?

What education should dietitians give patients with type 1 diabetes mellitus (DM)?

Presentation

What are the most common symptoms of type 1 diabetes mellitus (DM)?

What causes polyuria in type 1 diabetes mellitus (DM)?

What causes symptoms of type 1 diabetes mellitus (DM)?

How soon after beta-cell destruction do patients with type 1 diabetes mellitus (DM) become symptomatic?

How is the onset of symptomatic type 1 diabetes mellitus (DM) characterized?

What are the signs and symptoms of type 1 diabetes mellitus (DM)?

What are the GI symptoms of type 1 diabetes mellitus (DM)?

What is frequency of neuropathy in type 1 diabetes mellitus (DM)?

What is the focus of medical history of a patient with type 1 diabetes mellitus (DM)?

What history is needed in patients with type 1 diabetes mellitus (DM) who use a pump or a multiple-injection regimen?

What information should be included in a type 1 diabetes mellitus (DM) history?

How is glycemic exposure in established type 1 diabetes mellitus (DM) assessed?

Which questions regarding hypoglycemia and hyperglycemia symptoms should be asked of patients with type 1 diabetes mellitus (DM)?

Which questions regarding microvascular complications should be asked of patients with type 1 diabetes mellitus (DM)?

Which questions regarding macrovascular complications should be asked of patients with type 1 diabetes mellitus (DM)?

Which questions regarding neuropathy should be asked of patients with type 1 diabetes mellitus (DM)?

Which questions regarding foot disease should be asked of patients with type 1 diabetes mellitus (DM)?

What are the physical findings characteristic of new-onset type 1 diabetes mellitus (DM)?

How often should patients with type 1 diabetes mellitus (DM) be examined?

What is included in a diabetes-focused physical exam?

How are the vital signs assessed in type 1 diabetes mellitus (DM)?

What is included in the funduscopic exam for type 1 diabetes mellitus (DM)?

What is included in the foot exam for type 1 diabetes mellitus (DM)?

Which factors increase the risk of infection in type 1 diabetes mellitus (DM)?

What are the most common sites of infection in type 1 diabetes mellitus (DM)?

Which infections occur almost exclusively in type 1 diabetes mellitus (DM)?

What are ophthalmologic complications of type 1 diabetes mellitus (DM)?

What is diabetic retinopathy?

What are the stages in the progression of diabetic retinopathy?

How does diabetic retinopathy progress in stage 1 and 2?

How does diabetic retinopathy progress in stages 3, 4 and 5?

What are renal complications of type 1 diabetes mellitus (DM)?

What are the types of diabetic neuropathy?

What is the most common type of diabetic neuropathy?

What are acute-onset mononeuropathies of type 1 diabetes mellitus (DM)?

What are cranial nerve complications of type 1 diabetes mellitus (DM)?

What are macrovascular complications of type 1 diabetes mellitus (DM)?

What are the risk factors for macrovascular disease in type 1 diabetes mellitus (DM)?

DDX

Which conditions and factors should be considered in the differential diagnosis of type 1 diabetes mellitus (DM)?

How are type 1 and type 2 diabetes mellitus (DM) differentiated?

How is monogenic diabetes differentiated from type 1 diabetes mellitus (DM)?

What are the differential diagnoses for Type 1 Diabetes Mellitus?

Workup

What is the role of HbA1c measurement in the diagnosis of type 1 diabetes mellitus (DM)?

What is the role of plasma glucose concentration in the diagnosis of type 1 diabetes mellitus (DM)?

What is the role of fingerstick glucose test in the diagnosis of type 1 diabetes mellitus (DM)?

How are glucose levels determined in the diagnosis of type 1 diabetes mellitus (DM)?

What are the ADA recommendations for the measurement of HbA1c in type 1 diabetes mellitus (DM)?

What are limitations of HbA1c levels in the diagnosis of type 1 diabetes mellitus (DM)?

What is an HbA1c assay indicated in the diagnosis of type 1 diabetes mellitus (DM)?

What are the advantages of HbA1c testing over glucose measurement for the diagnosis of type 1 diabetes mellitus (DM)?

What is the HbA1c criterion for diagnosis of type 1 diabetes mellitus (DM)?

What effect does seasonal variability have on HbA1c levels used for diagnosis of type 1 diabetes mellitus (DM)?

What is the role of HbF in the diagnosis of type 1 diabetes mellitus (DM), and what are the concerns regarding the accuracy of HbA1c testing?

What are the ADS guidelines for use of HbA1c in the management of type 1 diabetes mellitus (DM)?

What is the role of fructosamine assay in the diagnosis of type 1 diabetes mellitus (DM)?

What is the role of WBC count and blood and urine cultures in the diagnosis of type 1 diabetes mellitus (DM)?

How is diabetic ketoacidosis (DKA) diagnosed?

Who should be screened for type 1 diabetes mellitus (DM)?

What are the AACE recommendations for distinguishing between type 1 and type 2 diabetes mellitus (DM)?

What are some classical symptoms of type 1 diabetes mellitus (DM)?

What is the role of islet-cell (IA2) levels in the diagnosis of type 1 diabetes mellitus (DM)?

Treatment

What is included in insulin therapy for type 1 diabetes mellitus (DM)?

When is little or no insulin therapy needed for type 1 diabetes mellitus (DM)?

What is the approach for treatment of new-onset type 1 diabetes mellitus (DM)?

What are the American Disease Association (ADA) treatment guidelines for type 1 diabetes mellitus (DM)?

What is the role of exogenous glucagonlike peptide 1 (GLP-1) in the treatment of type 1 diabetes mellitus (DM)?

When is pancreatic transplantation indicated for the treatment of type 1 diabetes mellitus (DM)?

What health risks are decreased with tight glycemic control in type 1 diabetes mellitus (DM)?

What are the benefits to tight glycemic control in type 1 diabetes mellitus (DM)?

How are HbA1c target levels determined in the treatment of type 1 diabetes mellitus (DM)?

Which health risks increase with tight glycemic control of type 1 diabetes mellitus (DM)?

What is the role of self-monitoring in the management of type 1 diabetes mellitus (DM)?

How frequently should plasma glucose be monitored in type 1 diabetes mellitus (DM)?

When is urine ketone testing indicated in type 1 diabetes mellitus (DM)?

What is the role of continuous glucose monitors (CGMs) in the treatment of type 1 diabetes mellitus (DM)?

What are the limitations of continuous glucose monitors (CGMs) for the treatment of type 1 diabetes mellitus (DM)?

What is the benefit of continuous glucose monitors (CGMs) for the treatment of type 1 diabetes mellitus (DM)?

When is the intermittent use of a continuous glucose monitor (CGM) indicated in the treatment of type 1 diabetes mellitus (DM)?

Which continuous glucose monitor (CGM) is the most accurate for type 1 diabetes mellitus (DM)?

What is the sensor-augmented insulin pump system for type 1 diabetes mellitus (DM)?

Which continuous glucose monitors (CGMs) have recently been FDA approved for the management of type 1 diabetes mellitus (DM)?

What is the role of artificial pancreases in the treatment of type 1 diabetes mellitus (DM)?

What types of insulin preparations are used in the treatment of type 1 diabetes mellitus (DM)?

What is the role of rapid-acting insulins in the treatment of type 1 diabetes mellitus (DM)?

What is the efficacy of rapid-acting inhaled insulin powder (Afrezza) in the treatment of type 1 diabetes mellitus (DM)?

What is the role of short-acting insulins in the treatment of type 1 diabetes mellitus (DM)?

Which type of insulin is the most effective for lowering postprandial hyperglycemia in type 1 diabetes mellitus (DM)?

What is the role of aspart (Fiasp) in the treatment of type 1 diabetes mellitus (DM)?

What is the role of Semilente insulin in the treatment of type 1 diabetes mellitus (DM)?

Which intermediate-acting insulins are used for the treatment of type 1 diabetes mellitus (DM)?

What is the role of lente insulin in the treatment of type 1 diabetes mellitus (DM)?

Which long-acting insulins are used for the treatment of type 1 diabetes mellitus (DM)?

What is the role of degludec (Tresiba) in the treatment of type 1 diabetes mellitus (DM)?

How are insulins mixed in the treatment of type 1 diabetes mellitus (DM)?

What is the role of ultrafast-acting insulin in the treatment of type 1 diabetes mellitus (DM)?

What is the evidence of increased cancer risk from insulin glargine (Lantus) treatment of type 1 diabetes mellitus (DM)?

How is insulin administered for the treatment of type 1 diabetes mellitus (DM)?

What are some common insulin regimens for the treatment of type 1 diabetes mellitus (DM)?

How quickly does insulin used for the treatment of type 1 diabetes mellitus (DM) expire?

How is the initial daily insulin dose calculated for type 1 diabetes mellitus (DM)?

How is the initial daily insulin dose calculated for children with type 1 diabetes mellitus (DM)?

What are the risks and benefits of administering multiple subcutaneous insulin injections for type 1 diabetes mellitus (DM)?

Which types of insulin are administered for the treatment of type 1 diabetes mellitus (DM)?

How should daily doses of insulin be adjusted in the treatment of type 1 diabetes mellitus (DM)?

How are small battery-operated infusion pumps used in the treatment of type 1 diabetes mellitus (DM)?

What is the role of continuous subcutaneous insulin infusion (CSII) in the treatment of type 1 diabetes mellitus (DM)?

What are the benefits of pump therapy for the treatment of type 1 diabetes mellitus (DM)?

How can early morning hyperglycemia be prevented in type 1 diabetes mellitus (DM)?

How do altitude changes affect insulin pump delivery in the treatment of type 1 diabetes mellitus (DM)?

What are the AACE/ACE guidelines for insulin pump management in type 1 diabetes mellitus (DM)?

Which are the signs and symptoms of insulin allergy?

What are the causes of hypoglycemia in type 1 diabetes mellitus (DM)?

What are symptoms of hypoglycemia in type 1 diabetes mellitus (DM)?

What are the health risks of repeated hypoglycemia in type 1 diabetes mellitus (DM)?

What is the evidence of cognitive impairment as a result of hypoglycemia in type 1 diabetes mellitus (DM)?

What are the risks of hyperglycemia in type 1 diabetes mellitus (DM)?

What is the treatment for hyperglycemia in type 1 diabetes mellitus (DM)?

What is the importance of follow-up following treatment of hyperglycemia in type 1 diabetes mellitus (DM)?

Which type 1 diabetes mellitus (DM) comorbidities may aggravate hyperglycemia?

What is diabetic ketoacidosis (DKA)?

What is the dawn phenomenon in type 1 diabetes mellitus (DM)?

What is the Somogyi phenomenon in type 1 diabetes mellitus (DM)?

How are the dawn and Somogyi phenomena in type 1 diabetes mellitus (DM) managed?

What is the role of insulin in the treatment of hyperglycemia in type 1 diabetes mellitus (DM)?

What is the ADA recommendation for dietary treatment of type 1 diabetes mellitus (DM)?

What is included in the diet management plan for type 1 diabetes mellitus (DM)?

What is the recommended caloric distribution for management of type 1 diabetes mellitus (DM)?

What are the recommended food group intakes for patients with type 1 diabetes mellitus (DM)?

What are the activity recommendations for management of type 1 diabetes mellitus (DM)?

Which infectious diseases are at higher risk in patients with type 1 diabetes mellitus (DM)?

What are the ophthalmologic complications of type 1 diabetes mellitus (DM)?

What are the dangers of nephrotoxic agents in patients with type 1 diabetes mellitus (DM)?

What the alternative to contrast-enhanced imaging for patients with type 1 diabetes mellitus (DM)?

What are the ADA recommendations for nephropathy screening in type 1 diabetes mellitus (DM)?

What are complications of micro- and macroalbuminuria in type 1 diabetes mellitus (DM)?

How is blood pressure controlled in type 1 diabetes mellitus (DM)?

What are complications of diabetic neuropathy?

What are complications of diabetic foot disease?

When is referral to a podiatrist indicated in the treatment of type 1 diabetes mellitus (DM)?

What is Charcot joint in type 1 diabetes mellitus (DM)?

What are macrovascular disease complications in type 1 diabetes mellitus (DM)?

What is the ADA recommended blood pressure goal for comorbid hypertension and type 1 diabetes mellitus (DM)?

How is atherosclerosis prevented in type 1 diabetes mellitus (DM)?

What is the risk of cardiovascular disease in patients with type 1 diabetes mellitus (DM)?

What is the association between silent ischemia and type 1 diabetes mellitus (DM)?

How are lipid abnormalities resolved in patients with type 1 diabetes mellitus (DM)?

What are the ADA guidelines on the use of statins in patients with type 1 diabetes mellitus (DM)?

How is type 1 diabetes mellitus (DM) managed during surgical procedures?

What are complication of serious medical illness or surgical procedures in patients with type 1 diabetes mellitus (DM)?

Why should near-normal blood glucose levels be maintained in medical and surgical patients with type 1 diabetes mellitus (DM)?

How is ketosis prevented in hospitalized patients with type 1 diabetes mellitus (DM)?

What insulin regimen should be used for patients with type 1 diabetes mellitus (DM) undergoing minor surgery?

When are the different types of insulin indicated for the treatment of type 1 diabetes mellitus (DM) in patients with restricted food intake prior to medical procedures?

Which types of insulin should be administered for prevention of hypoglycemia in hospitalized patients with type 1 diabetes mellitus (DM)?

What effect does cardiovascular disease or renal dysfunction have on the morbidity and mortality of patients with type 1 diabetes mellitus (DM)?

What are the insulin therapy requirements in critically ill patients with type 1 diabetes mellitus (DM)?

What are the ADA recommended blood glucose goals for non-critically ill patients with type 1 diabetes mellitus (DM)?

What are the ACP guidelines for glycemic control in hospitalized patients with type 1 diabetes mellitus (DM)?

How are plasma glucose and ketones monitored in patients with type 1 diabetes mellitus (DM) undergoing surgical procedures?

When is insulin administered for type 1 diabetes mellitus (DM) in patients undergoing surgical procedures?

What is the postoperative standard of care for type 1 diabetes mellitus (DM)?

What are the treatment options for type 1 diabetes mellitus (DM) during pregnancy?

Which trials have been conducted on the prevention of type 1 diabetes mellitus (DM)?

What were the results of the Diabetes Prevention Trial-Type 1 (DPT-1)?

What is the role of nicotinamide in the prevention of type 1 diabetes mellitus (DM)?

What is the role of antigen-based immunotherapy in the prevention of type 1 diabetes mellitus (DM)?

What is the role of teplizumab in the prevention of type 1 diabetes mellitus (DM)?

What is the role of abatacept in the prevention of type 1 diabetes mellitus (DM)?

What are the recommended referrals for patients with type 1 diabetes mellitus (DM)?

Guidelines

What are the A-grade recommendations from the American Diabetes Association’s Standards of Medical Care in Diabetes 2018?

What is contained in the American Diabetes Association (ADA) position statement on type 1 diabetes in children and adolescents?

What are the ADA guidelines on managing hypertension in type 1 diabetes mellitus (DM)?

What are the ISPAD guidelines on diabetic vascular complications in children and adolescents with type 1 diabetes mellitus (DM)?

What are the ISPAD clinical practice consensus guidelines on glycemic control targets and glucose monitoring in type 1 diabetes mellitus (DM)?

Medications

What is the first-line treatment for type 1 diabetes mellitus (DM)?

Which medications in the drug class Hypoglycemia Antidotes are used in the treatment of Type 1 Diabetes Mellitus?

Which medications in the drug class Antidiabetics, Amylinomimetics are used in the treatment of Type 1 Diabetes Mellitus?

Which medications in the drug class Antidiabetics, Insulins are used in the treatment of Type 1 Diabetes Mellitus?