Why is insulin life-saving in type 1 DM?
Prevents Diabetic ketoacidosis (DKA)
What is the long-term goal of insulin treatment?
Prevent chronic complications of poor glycaemic control
What do the current guidelines recommend for HbA1c?
< 18 years: < 59mmol/mol
>18 years: < 53mmol/mol
What are the current guidelines regarding exercise in T1DM?
150 minutes of moderate-intense execise weekly
Spread over 3 days, no more than 2 consecutive days without
A carbohydrate snack should be given before exercise if blood glucose levels are below which point?
< 5.6 mmol/l
After diagnosis, when should insulin therapy be started?
How does insulin administration aim to mimic physiological insulin release?
Combining a basal insulin with bolus dosing at mealtimes
Give 3 examples of long acting insulins
Which intermediate-acting insulin is often used for basal dosing?
Give 3 examples of rapid acting insulins
What is a frequent cause of nocturnal hypoglycaemia?
Dinnertime NPH (or other intermediate-long acting insulin)
Which other coexistant conditions contribute to more unstable diabetes?
- Coeliac disease
- Thyroid disease
- Addison's disease
- Psychosocial stress
If there is a concern for noctural hypoglycaemia, what should a patient do?
Take a 3am blood glucose test
Why are both alcohol and exercise potentially dangerous in T1DM?
They can cause delayed hypoglycaemia
(by up to 24 hours)
In patients with uncontrolled postprandial hyperglycaemia, which adjunctive treatment can be used?
What is pramlintide?
What is amylin and what is its physiological function?
A hormone secreted with insulin normally (not at all in T1DM) which promotes the acute 1st phase of the insulin response by:
- Slowing gastric emptying
- Promoting satiety
- Inhibiting inappropriate glucagon secretion
What is the recommened HbA1c level before conception?
< 48 mmol/mol
The target during pregancy is 43 mmol/mol
Why should women be evaluated before pregancy?
- Poor glycaemic control may damage foetus
- Retinopathy, nephropathy, neuropathy and CVD in the mother may worsen in pregnancy if it is present
Which condition is more common in pregnant women with diabetes?
Women with diabetes are at increased risk of having a baby with which type of defect?
Neural tube defects
(spina bifida, anencephaly etc.)
Which treatment is given to diabetic women to reduce the liklihood of their baby developing neural tube defects during pregancy?
(prior to (0.4mg) and during pregancy (5mg))
What is the first line treatment for T1DM in non-pregnant adults?
Basal insulin (glargine, NPH, detemir or degludec)
Bolus insulin (regular, lispro, aspart or glulisine) OR pump
What are the potential adjunct therapies for the first line T1DM treatment?
- Pre-meal insulin correction dose
- Amylin analogue (e.g. pramlintide)
What is the second line treatment for T1DM?
Fixed Insulin Dose
Insulin isophane biphasic
Insulin aspart biphasic
Insulin lispro biphasic
Insulin degludec/insulin aspart
When would a fixed-dose insulin regimen be used?
- Already doing well on a fixed dose
- Cannot manage 3-4 daily injections
- Has trouble mixing insulin
What is the first line treatment for someone who is pregnant and has T1DM?
Basal insulin (NPH or detemir)
Bolus insulin (regular, lispro or aspart)
What is the second line treatment for someone who is pregant and has type 1 diabetes?
Basal insulin (glarcine)
Bolus insulin (regular, lispro or aspart) OR pump
How often should patients have their HbA1c checked?
- Meeting treatment goal (< 59 mmol/mol (< 18 years) or < 53mmol/mol (> 18 years) - Every 6 months
- Therapy is being modified or not meeting goal - Every 3 months
- Pregnant - Every month
If patients with T1DM also have atherosclerotic CVD, which treatment should they also be on as well as standard insulin and adjunctive treatments?