Management of Type 1 Diabetes Flashcards
1
Q
How to assess a newly diagnosed pt with T1DM?
A
- History
- Examination
- Investigations - bloods
2
Q
Questions to ask in history for T1DM
A
- Onset - acute, short
- Osmotic symptoms - polyuria, polydipsia, weight loss, fatigue
- PMH - endocrinopathies eg Cushings, Acromegaly, thyrotoxicosis, PCOS
- FH - diabetes and ethnic origin
- Other autoimmune disease
- Exocrine pancreas function - pancreatitis?
- Meds
3
Q
What drugs can cause T1DM?
A
- Steroids
- Levothyroxine
- Diazoxide
- Beta agonists
- Thiazides
- HIV drugs
4
Q
Things to examine on someone with DM
A
- BMI - central obesity? signs of T2DM?
- BP - CV risk
- Signs of insulin resistance
- Precipitating cause exam - pancreas failure?
- Dysmorphic features - eg Downs, Klinefelters
- Feet examination - do on patient in every interaction with diabetes
- Refer for retinal screening
- Examine injection sites?
5
Q
Signs of insulin resistance
A
- Central obesity
- Acanthosis nigricans - darkening skin in folds esp
- Hyperandrogenism in females - eg hirsuitism, acne
6
Q
Bloods for diagnosed DM
A
- HbA1C
- U&Es - nephropathy?
- LFTs - fatty liver disease?
- FBC - anaemia of chronic disease?
- Thyroid function - Type 1 associated with hypothyroidism
- Lipid profile
- B-cell antibodies, anti-GAD, anti-islet cells
- Coeliac screen
7
Q
Pathophysiology of T1Dm
A
- Absolute insulin deficiency
- Secondary to T cell mediated autoimmune destruction
- Anti glutamic acid decarboxylase (GAD), islet autoantigen (I-A2) present in most people
8
Q
Overall management of T1DM
A
- Education
- Insulin therapy
9
Q
Education for people newly diagnosed with T1DM
A
- Explanation of Diabetes
- Aims of treatment - why do we treat?
- Home monitoring - 4x daily
- Injection technique
- Dietary advice - flexible insulin therapy advice too
- Suggested targets
- Hypoglycaemia risk and management of this
- Annual screening info - bloods, urine and eye screening
- DVLA and insurance
- Pregnancy - avoid pregnancy until HbA1C <48mmol/L
10
Q
When do patients with T1DM monitor blood sugar at home?
A
- 4x daily
- Fasted
- Pre lunch
- Pre dinner
- Bedtime
11
Q
Targets for blood sugar levels T1Dm
A
- Premeal - 4.0-7.0mmol/L
- Post meal - 5-9mmol/L - but do not often monitor this usually unless problem
- HbA1C - 48mmol/mol (6.5%) or lower
12
Q
Targets for BP and BMI T1Dm
A
BP <140/90 or <130/80 if kidney disease
BMI 20-25
13
Q
Dietary advice for T1DM
A
- No restrctions with diet unless overweight
- Calculate insulin based on carbohydrate in meal usually
14
Q
DVLA for people with Diabetes Mellitus
A
- Inform DVLA if on insulin
- Blood sugar must be 5 to drive
- Long journeys monitor every 2 hrs
- If have hypo, can drive 45 minutes after blood sugar levels have normalised (NOT AFTER FOOD BUT AFTER NORMAL)
15
Q
What is DAFNE?
A
- Dose adjustment for normal eating
- Flexible insulin regime
- Insulin dose calculated based on carbohydrate in food
16
Q
Normal daily insulin requirements
A
- 0.5-0.6 units/kg/day
- Adolescents may need 0.8-1unit/kg
17
Q
How do we calculate physiological replacement for insulin?
A
- Split daily requirement into 2
- Basal (background dose) and bolus (mealtime, quick acting) insulin
18
Q
What is background insulin affected by?
A
- Weight
- Stress
- Exercise
- Alcohol