Management of Type 1 Flashcards by Sophia Boyce

What are the 4 aims in management of type 1 DM?

prompt diagnosis !!
encouragement of appropriate self management skill set
correction of acute metabolic upsets at diagnosis + thereafter
facilitate long term health + well being

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How many type 1 diabetics are diagnosed in DKA?

1 in 4 !

1 in 3 under 5yrs

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3 steps to early diagnosis of type 1 DM?

THINK symptoms
TEST immediately
TELEPHONE urgently

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What are the 4 Ts of type 1 DM (THINK symptoms)?

Thirsty
Tired
Thinner
Using Toilet more

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What is a ‘red flag’ symptom of type 1?

Return to bedwetting or daywetting in a prev dry child

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What is the immediate test for type 1 and the result in a diabetic?

Finger prick capillary blood glucose test

>11mmol/l

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What 4 things should u NOT do in suspected type 1?

Request returned urine specimen
Arrange fasting BG test
Arrange OGTT
Wait for lab results

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What should you request in suspected type 1?

SAME DAY review from local paediatric specialist diabetes team

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What are some strategies to support people with type 1 DM?

education
nutrition and lifestyle management
skills training
insulin (analogues, pens, pumps)

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What other symptoms of type 1 should u consider in children under 5?

Heavier nappies
Blurred vision 
Candidiasis (oral/vulval)
Constipation 
Recurring skin infection 
Irritability/behaviour change

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What 4 things should u check before injecting insulin?

Right INSULIN
Right DOSE
Right TIME
Right WAY

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What are the ways insulin can be administered and in what situations?

Injected subcutaneously (usual route)
IV (illness/surgery)

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Soluble insulin needs to be injected 30 mins before eating as they associate with hexamers, what type of insulin CAN be injected just before a meal?

Rapid acting analogues

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What should the amount of insulin injected for meals balance?

The carbohydrate intake consumed

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Name some methods of education on type 1 DM

Patient handbooks
Leaflets
Websites
Education days
Health care prof education 
House of Care
My Diabetes My Way
Insulin Pump starts

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What are the 2 methods of home BG monitoring?

Finger prick capillary testing

Permanent pump

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What are the 5 different insulins in terms of duration of action?

RAPID acting (lispro, aspart (analogue))
SHORT acting (soluble, actrapid, Humulin S)
INTERMEDIATE acting (Isophane, insulatard, Humulinl)
LONG acting (glargine (analogue), detemir, degludec)
CSII (continuous sub-cutaenous insulin infusion)

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What are 4 things to consider in insulin injection technique?

Needle size
Location
Rotation of injection site
Technique

What are good sites for insulin injection?

Fatty areas - buttocks, lower stomach, thighs

What does the twice daily insulin regimen involve?

Rapid acting mixed with intermediate acting

BB and BT

What does the three times daily insulin regimen involve?

Rapid mixed with intermediate BB
Rapid BT
Intermediate BBed

What does the four times daily regimen involve?

Short BB, BL, BT

Intermediate BBed or long acting at fixed time once daily

How many units of Rapid per 10g CHO?

What is CSII and what does it involve?

Continuous Subcutaneous Insulin Infusion

All the time there is a basal amount of insulin being delivered; this can go up or down controlled by patients

Why would patients alter their CSII levels?

Decrease when exercising Increase when unwell When eating carbs type in how much they are having

What is hypoglycaemia?

Any episode of low BG (<4mmol/l) with or w/o symptoms

What is required in a severe hypo (when patient is no longer able to self manage)?

Third party intervention

Give reasons for hypo

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

Even if untreated, how do most isolated hypo episodes recover?

Spontaneously

What are the 3 categories in the Edinburgh Hypoglycaemia Scale?

Autonomic Neuroglycopenic General malaise

Describe the symptoms in each category of the EHS

A: sweating, palpitations, shaking, hunger N: confusion, drowsiness, odd behaviour, speech difficulty, incoordination GM: headache, nausea

What is inability to perceive normal warning symptoms of hypo associated with?

Recurrent severe hypo Long duration of disease Over tight control Loss of sweating/tremor

All patients treated with insulin or sulphonylureas are advised to carry what with them?

Carbohydrates

What are 3 possible effects of hypo?

Coma Hemiparesis Seizures

What can happen is hypo is prolonged?

Neurological deficits may become permanent

What is the treatment for hypo?

15-20g simple CHO | 5-7 dextrosol/4-5 glucotabs; 200ml fruit juice

If unable to take oral CHO, what is the treatment? (in hospital and out)

Out - 1mg im glucaon; GlucoGel/Dextrogel | In - 75-80ml 20% glucose of 10% glucose or 20-50mls 50% dextrose iv

What is the follow up for a hypo?

Long-acting CHO

What are symptoms of DKA?

``` Polyuria Polydipsia Weight loss Weakness Nausea/vomiting Abdo pain Breathlessness ```

What are signs of DKA?

``` Dry mucous membranes Sunken eyes Tachycardia Hypotension Ketotic breath Altered mental state Hypothermia ```

What are the initial investigations for DKA?

``` RAPID A, B, C IV access Vital signs Clinical assessment Full clinical examination Glucose Venous blood gas Urinalysis/blood ketones U+E, FBC Culture blood/urine ECG + cardiac monitor Consider CXR ```

What could cause DKA?

Infection; severe stress; insulin omission

What are some complications of DKA?

- Hyper/hypo- kalaemia - Hypoglycaemia - Cerebral oedema - Aspiration pneumonia - Arterial + venous thromboembolism - ARDS

What is the treatment for DKA in hospital HDU?

``` IV saline IV insulin IV potassium in saline May need abx Consider heparin, NG tube ```