T1DM

Question 1

How would you explain diabetes to a patient

Answer 1

Autoimmune disease in which the body’s immune system attacks the beta cells of the pancreas. As the beta cells release insulin this leads to chronically high blood glucose levels

Question 2

What are the signs and symptoms of T1DM

Answer 2

Polyuria
Excess thirst
Excess fatigue
Unintentional weight loss
Genital itching
Cuts and wounds take longer to heal
Blurred eyesight
Increased hunger

Question 3

What is basal insulin
Give an example

Answer 3

• long acting
• works in background and does job of pancreas
• works within 2 hours
• lasts 18-24 hours

E.g. determir, glargine

Question 4

What is bolus insulin
Give an example

Answer 4

• fast acting
• taken 10-15 mins before meals as correction dose to target carbohydrates from food
• lasts 2-5 hours

E.g. aspart

Question 5

You have a patient with T1DM who wants to start exercising to support some weight loss for a wedding they are going to. What would you need to consider?

Answer 5

Weight loss will likely mean the patient will require a reduction in insulin as weight loss tends to increase insulin sensitivity
Aerobic activity will likely decrease blood glucose levels
Anaerobic activity - weight lifting - will likely increase blood glucose levels - however they tend to drop quite quickly (1/2 hours afterwards) if people don’t have a post workout meal or snack

Question 6

Explain the dietary management of T1DM and the principles of carbohydrate counting

Answer 6

• eat 3 regular meals - carbohydrate LOW GI at every meal time
• keep eye on portion size
• remember all carbohydrates have an effect on blood glucose
• reduce fat intake, especially saturated fat
• eat more fruit and veg
• eat more fish - 2 portions a week, 1 oily
• include more beans and lentils
• limit sugar and sugary foods and drinks
• choose snacks under 15g total carbohydrates per portion

Carbohydrate counting
- eat similar amounts of carbohydrates every day
- learn to adjust their insulin dose (using insulin to carbohydrate ratios and correction factors) to match the amount of carbohydrates they wish to eat
- correction factors can also be used - if a patients blood glucose level is 12mmol/L and their correction factors is 1unit of insulin:3mmol/L then taking 1 unit of insulin will bring their blood glucose levels down to 9mmol/L

Question 7

A patient with T1DM asks if its okay for them to drink alcohol. What would your response be and what would they need to consider

Answer 7

Should minimise intake - maximum 14 units
Discourage alcopops, sweet liqueurs and mixers high in sugar
Sugar free mixers are encouraged

Question 8

When carrying out a nutritional assessment of a patient with T1DM what would need to be considered at each stage?

Question 9

What is diabetic ketoacidosis

Answer 9

In the absence of any insulin, people with T1DM break down fats/proteins instead of carbohydrate and rely on its by products, for energy
Small amounts of ketones can be used for energy, but large amounts cause the blood to turn acidic
Resulting in diabetic ketoacidosis

Question 10

Hypoglycaemia treatment

Answer 10

15-20g of carbohydrates
- 200ml pure fruit juice
- 250ml lucozade
- 4-5 jelly babies
- 3-5 glucose tablets
- 150-200ml sugary drinks