Lecture 16 Management of Type 1 Diabetes Flashcards
What steps are involved in making an early diagnosis
THINK- Symptoms • Thirsty • Thinner • Tired • Using the toilet more
In children under 5 what other symptoms can be used to diagnose
- Heavier than usual nappies
- Blurred vision
- Candidiasis (oral, vulval)
- Recurring skin infections
- Irritability, behaviour change
Whats the first line management if type 1 diabetes is suspected
• Finger prick capillary glucose test
• If result >11mmol/l
Telephone- Urgently
• Contact local specialist for same day review
What are the symptoms of DKA
- Nausea & Vomiting
- Abdominal pain
- Sweet smelling, ketotic breath
- Drowsiness
- Rapid, deep sighing respiration
- Coma
Strategies to support people with type 1 diabetes
Education
Nutrition and lifestyle management
Skills training
Insulin- analogues, pens, pumps
Describe the sick day rule for type 1 diabetes
Insulin should never be stopped
May need to increase insulin dose
Blood glucose levels should be checked at least every 2-4 hours
Drink sugar free fluids to avoid dehydration
Aim for blood glucose of 6-10mmol/L
Why does insulin need to be given 30 minutes before eating
In subcutaneous fat the insulin molecule has the tendency to self-associate into hexamers. Hexamers need to dissociate into monomer before absorption through capillary bed
Do rapid acting analogues need to be administered 30 minutes before eating
No
Name methods of education for type 1 diabetics
Any of these: • Patient handbooks • Leaflets • Websites • Pregnancy • Insulin pump starts • Rolling programs/Topics • Education days • CGM starts • Apps CHO/fitness • Health care professional education • House of care • Online • My Diabetes My Way • Think Check Act • 3rd sector • Set curriculum (DIANE)- Diabetes Insulin Adjustment for Normal eating Course
Name rapid acting insulin
– Insulin lispro
– Insulin aspart
Name short acting insulin
– Soluble insulin
– Actrapid
– Humulin S
Name immediate acting insulin
– Glargine
– Detemir
– Degludec
Name long acting insulin
– Levemir
Whats another form of insulin
• Continuous sub cutaneous insulin infusion (CSII)
Describe the twice daily insulin regimen
- Rapid acting mixed with intermediate acting
* Before breakfast (BB) and evening meal (BT)
Describe the three times daily insulin routine
- Rapid acting mixed with intermediate acting BB
- Rapid acting BT
- Intermediate acting at bedtime BBed
Describe the four times daily insulin routine
- Short acting BB BL BT
* Intermediate BBed or long acting insulin at a fixed time once daily
What are the causes of hypoglycaemia
- Too little of wrong type of food
- Activity during/after
- Insulin dose, injection technique
- Alcohol
What groups are at risk of hypoglycaemia
- Tight glycaemic control
- Impaired awareness
- Cognitive impairment
- Extremes of age
- Malabsorption/gastroparesis
- Abrupt steroid withdrawal
- Coeliac disease
- Renal/hepatic impairment
- Pancreatectomy
- Pregnancy
What are autonomic features of hypoglycaemia in the Edinburgh scale
Sweating
Palpitations
Shaking
Hunger
What are neuroglycopenic features of hypoglycaemia in the Edinburgh scale
Confusion Drowsiness Odd behaviour Speech difficulty Incoordination
How is hypoglycaemia treated
15-20g of simple CHO, dextrosol, Glucotabs. Glucogel/Dextrogel or IV dextrose
What should be included in a hypobox
- Fruit juice
- Dextro energy
- Glucogel
- 20% or 50% dextrose
- Hypo management protocol
How can hypoglycaemia be avoided
• Blood glucose monitoring
• Rotate and check injection sites
• Review snack and diet- carb counting
Change insulin regimen
