Lecture 20: Management of Type 1 Diabetes

Question 1

List the current strategies to support and treat people with type 1 diabetes

Answer 1

Education:
- team based DSN, dietitian, doctor.
- structured education e.g. STEP (DIANE, doe adjustement for normal eating)
- person with diabetes is main team member

Nutrition and lifestyle management:
- CHO counting
- physical exercise

Skills training:
- home blood glucose monitoring
- injection technique
- hypos
- sick day rules

Insulin: analogues, pens and pumps

Question 2

diabetic ketoacidosis DKA symptoms

Answer 2

• nausea and vomiting
• abdominal pain
• sweet smelling, ‘ketotic’ breath
• drowsiness
• rapid, deep ‘sighing’ respiration
• coma
• polyuria

Question 3

sick day rules for type 1 diabetics

Answer 3

Check BG and ketones if unwell.
Check ketones even if BG ‘normal’ if unwell
NEVER stop insulin: continue basal

Question 4

ketoacidosis signs

Answer 4

• dry mucous membranes
• sunken eyes
• tachycardia
• hypotension
• ketotic breath
• Kussmaul resp.
• altered mental state
• hypothermia

Question 5

diagnosis of diabetic ketoacidosis

Answer 5

1. ketonaemia/ketonuria
2. metabolic acidosis
3. usually with hyperglycaemia

Question 6

what to do if you have blood ketones and your blood sugar level is 14 or above?

Answer 6

blood ketones < 0.6mmol/l is normal, repeat test after 2 hours to check level isnt rising

blood ketones 0.6-1.4mmol/l > risk of DKA > drink plenty of sugar free fluids, give a correction dose of insulin and retest blood sugar and ketones 1-2 hourly

1.5-2.9mmol/l > risk of DKA > as above and contact diabetes team for advice

3.0 or above > DKA > as above and phone URGENT MEDICAL ADVICE - to attend PAU

Question 7

treatment for DKA

Answer 7

fluid replacement and insulin

Question 8

complications of DKA

Answer 8

• hyper and hypokalaemia
• hypoglycaemia: rebound ketosis, arrhythmias, acute brain injury
• cerebral oedema
• aspiration pneumonia
• arterial and venous thromboembolism
• ARDS

Question 9

causes of hypoglycaemia

Answer 9

• too much insulin/SU
• inappropriate timing of insulin/SU
• injection site problems
• inadequate food CHO intake/fasting
• exercise
• alcohol

Question 10

what is found in an emergency hypobox?

Answer 10

• fruit juice
• dextrose tabs
• glucogel
• 20% or 50% dextrose
• hypo-management protocol

Question 11

how can we facilitate long-term health and wellbeing in a diabetic patient?

what specific health risk can we manage?

Answer 11

• optimal blood glucose control (HbA1c) to reduce microvascular disease and to improve pregnancy outcome.
• optimal blood pressure control to reduce nephropathy.
• manage CV risk factors e.g. smoking, cholesterol
• screen for early detection of complications: feet, eyes and kidneys