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D&E Pathology > Management of Type 1 DM > Flashcards

Management of Type 1 DM Flashcards

1
Q

What are the aims of T1DM management?

A
  • Prompt diagnosis
  • Encourage appropriate self-management
  • Correction of acute metabolic upsets
  • Facilitate long-term health
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2
Q

What immune factors take place in T1D?

A 
Islet autoantibodies
HLA class 2 association
Beta-cell T cells found in human islets
Immune modulation delays progress
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3
Q

How many children are diagnosed with diabetes every year?

A

300

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4
Q

How are a large portion of children diagnosed with diabetes?

A

1 in 4 present with DKA

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5
Q

Symptoms of childhood T1D?

A

Thirsty
Thinner
Tired
Toileting more

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6
Q

What must be done for suspected diabetes?

A

THINK - symptoms
TEST - capillary glucose
TELEPHONE - specialist for same day review

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7
Q

What capillary glucose is suggestive of T1D?

A

> 11mmol/L

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8
Q

What is the red flag symptom of childhood diabetes?

A

Return to bedwetting

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9
Q

What key symptoms are more common in children under 5?

A 
Heavier nappies
Blurred vision 
Candidiasis 
Constipation
Recurring skin infections
Irritability, behaviour changes
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10
Q

Symptoms of DKA?

A 
Nausea and Vomiting
Abdominal Pain
Polyuria
Polydipsia
Ketotic breath
Drowsiness/Confusion
Rapid "sighing" breath - Kussmaul
Coma
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11
Q

What should you do for a patient suspected to be in DKA?

A

Finger prick test

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12
Q

Who should you call in a DKA positive child?

A

Paediatric diabetes team same day

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13
Q

What blood tests should be performed in a suspected DKA patient after prick test?

A

Blood Glucose

Blood ketones

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14
Q

What strategies are in place to support T1D patients?

A

Education
Nutrition and lifestyle management
Skills training
Insulin

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15
Q

What should be checked before giving insulin?

A

Right insulin
Right dose
Right time
Right way - medium

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16
Q

Why must insulin be injected?

A

Its inactivated by the GIT

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17
Q

Why is insulin injected before eating?

A

Insulin in fat forms hexamers which take approximately 30 mins before breaking up

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18
Q

What are rapid acting analogues?

A

This Insulin does not associate and can be injected right before eating

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19
Q

What are the fast acting analogues?

A

Insulin lispro

Insulin aspart

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20
Q

What are the slow acting analogues?

A

Insulin glargine

Detemir insulin

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21
Q

What is the rough ratio of units of fast acting insulin to grams of sugar?

A

1 unit of insulin for 10g of carbs

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22
Q

What factors can be considered part of educating diabetic patients?

A

Handbooks, leaflets, Insulin pump starts, pregnancy, education days, help groups
Mydiabetes myway

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23
Q

What things need to be in a structured education of a T1D patient?

A 
Dealing with real life issues
Food
Exercise
Travel
Insulin
Blood testing/hypo
Sick days
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24
Q

When is a patient in DKA?

A

Blood ketones >3mmol/L

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25
At what blood ketone level should a diabetes team be contacted?
>1.5mmol/L
26
What is a normal ketone level?
<0.6mmol/L
27
What do you do if you have a ketone level between 0.6-1.4 and blood sugar >14?
Drink sugar fluids Correction dose insulin Retest in 1-2hrs
28
What do you do if you have a ketone level below 0.6 and blood sugar >14?
Retest in 1-2hrs
29
What do you do if you have a ketone level between 1.5-2.9 and blood sugar >14?
Drink sugar fluids Correction dose of insulin Retest hourly CONTACT DIABETES TEAM
30
What do you do if you have a ketone level over 3 and blood sugar >14?
Sugar fluids Correction dose insulin Retest hourly Attend hospital probs lol
31
What types of insulin action are there?
``` Rapid acting Short acting Intermediate acting Long acting Continuous subcutaneous infusion ```
32
What are the current insulin regimens?
Twice daily Three daily Four times daily
33
What is the regimen for twice daily insulin?
Rapid mixed with intermediate acting | Before breakfast and evening meal
34
What is the regimen for three times daily insulin?
Rapid mixed with intermediate before bed Rapid acting before evening meal Intermediate at bedtime
35
What is the regimen for four times daily insulin?
Short acting before breakfast, lunch and dinner Intermediate before bed OR Long acting at fixed time once each day
36
What factors can be adjusted to help with care of a T1D patient?
``` Lifestyle Exercise Driving Alcohol Contraception Drugs Holidays Employment ```
37
What is hypoglycaemia?
ANY episode of low blood sugar <4mmol/L with or without symptoms
38
What factors cause hypoglycaemia in a T1D patient?
``` Activity Food Insulin - timing, volume, injecton site Alcohol Oral hypoglycaemics ```
39
Which groups are at high risk of hypoglycaemia?
``` Tight glycaemic control Lowered awareness/cognitive function Extremities of age Malabsorption Hypoadrenalism Renal impairment Pancreatectomy Pregnancy Coeliacs ```
40
What should patients be taught about hypoglycaemia?
How to avoid, recognise and treat it
41
What are the symptoms of hypoglycaemia?
Vary between individuals Autonomic Neuroglycopenic Malaise
42
What are the autonomic symptoms of hypoglycaemia?
Sweating Palpitations Shaking Hunger
43
What are the neuroglycopenic symptoms of hypoglycaemia?
``` Confusion Drowsiness Odd behaviour Speech difficulty Incoordination ```
44
INABILITY TO PERCIEVE NORMAL WARNING SYMPTOMS OF HYPOGLYCAEMIA is associated with what?
Recurrent severe hypo Long duration of disease Loss of sweating/tremor Over tight control
45
Which patients should be told to carry CHO with them?
Patients on insulin or sulphonylureas
46
How should hypoglycaemia be treated in a patient able to take oral CHO?
``` If able to take oral CHO: 15-20g simple CHO 5-7 dextrosol/4-5 glucotabs 200ml fruit juice Follow up with long acting CHO ```
47
How should hypoglycaemia be treated in a patient unable to take oral CHO?
``` Out of hospital: - 1mg IM glucagon - Glucogel/dextrogel Hospital: - 75-80ml 20% glucose IV - 25mls 50% dextrose IV Follow up with long acting CHO ```
48
All patients in hypo should have their treatment followed up with what?
Long acting CHO
49
Whats in the Hypobox?
``` Fruit juice Dextro energy Glucogel 20% or 50% dextrose Hypo management protocol ```
50
What should you do with the patient after recovery?
``` Establish cause of hypo Control/monitoring? Hypoglycaemia awareness Repeated injection site? Driving/work ```
51
How can hypos be avoided in insulin-treated diabetes?
``` Blood glucose monitoring Rotate injection sites Review snacks and diet Consider changing regimen Avoid low glucose Insulin before + after exercise ```
52
How should diabetic patients approach driving?
Always carry carbohydrates No driving if not aware Measure glucose before No more than 1 hypo in a year
53
What are the symptoms of DKA?
``` Polyuria Polydipsia Weight loss Weakness N+V Abdo pain Breathlessness ```
54
What are the signs of DKA?
``` Ketone breath Coma Hypotension Tachycardia Altered mental state Sunken eyes Dry mucus membranes Kussmaul breathing ```
55
What patients are at risk of DKA?
T1DM Inadequate insulin Infection
56
What are the rules of managing diabetes with acute illness?
``` Never stop insulin Increase/adjust insulin More frequent checks Check urine/blood for ketones Carbohydrate intake must be maintained ```
57
How does increased glucagon aid to trigger DKA?
Increased lipolysis
58
How does increased cortisol aid to trigger DKA?
Decreased glucose utilisation
59
How does increased GH aid to trigger DKA?/??\/????
Increased proteolysis | Decreased protein
60
How does increased catecholamines aid to trigger DKA?
Increased Glycogenolysis leading to increased gluconeogenesis
61
What investigations should be done on a suspected DKA?
``` Rapid ABC Iv access Vitals Glucose ABG U+E, FBC Blood culture ECG Consider CXR ```
62
Complications of DKA
``` Hyper/hypokalaemia Hypoglycaemia Cerebral oedema Aspiration pneumonia Thromboembolism ARDS ```
63
Cerebral oedema is more common in who? How does it present?
Children | Hyperosmolar hyperglycaemic state
64
How is DKA treated in the HDU?
``` IV saline Iv insulin Iv Potassium ?heparin, NG tube FIND OUT WHY IT HAPPENED ```

D&E Pathology (18 decks)

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