Type 1 diabetes

Question 1

What is type 1 diabetes

Answer 1

insulin deficiency - destroyed beta cells in islet of langerhans

Question 2

when is type 1 most common

Answer 2

before adulthood

Question 3

typical features of type 1

Answer 3

-hyperglycaemia >11mmol/l
-ketosis
-rapid weight loss
-BMI <25
-<50yr
-FH of autoimmune disease

Question 4

how often should blood glucose be monitored and when?

Answer 4

-four times a day including before each meal and before bed
-walking
-fasting BG before meals
-90 mins after eating
-driving

Question 5

how many meals should type 1 diabetics have?

Answer 5

3 meals always

Question 6

what is the target level for walking

Answer 6

5-7

Question 7

what is the target level for fasting BG before meals

Answer 7

4-7

Question 8

90 minutes after eatingwhat is the target level 90 minutes after eating

Answer 8

5-9

Question 9

what is the target level for driving

Answer 9

> 5

Question 10

what are the insulin regimens

Answer 10

1) multiple daily dose injections **basal-bolus **
2) bipharic mixture
3) continuous SC insulin infusion (insulin pump)

Question 11

what is included in multiple daily injection basal-bolus insulin regimen

Answer 11

-basal (long/intermediate acting) OD/BD AND
-bolus (short/rapid acting) before meals

Question 12

what is first line basal insulin regimen

Answer 12

detemir BD

Question 13

What is second line basal insulin regimen

Answer 13

glargine OD

Question 14

What is included in bipharic mixture insulin regimen

Answer 14

short acting mixed with intermediate insulin inj 1-3 times a day

Question 15

when is continuous SC insulin infusion (insulin pump) insulin regimen given?

Answer 15

in adults = suffer disabling/uncontrolled hypoglyc

Question 16

insulin requirements for more insulin

Answer 16

infection
stress
trauma

Question 17

insulin requirements for less insulin

Answer 17

-physical activity
-intercurrent illness
-less food intake
-impaired renal function
-thyroid disorders
-coeliac disease
-addisons disease

Question 18

why is insulin given by SC

Answer 18

if oral it will be inactivated by GI enzymes

Question 19

what are the injection sites for insulin

Answer 19

-body areas with SC fat
-abdomen (fastest absorption sites)
-outer thigh/buttocks (slower)

Question 20

why do you need to rotate sites when injecting

Answer 20

lipohypertropy can occur due to repeatedly inj same small area erratic absorption of insulin

Question 21

what are the different types of short acting insulin?

Answer 21

-soluble insulin
-rapid-acting insulin

Question 22

what is in soluble insulin

Answer 22

human + bovine/porcine

Question 23

when should soluble insulin be injected?

Answer 23

15-30 mins before food

Question 24

what is onset of soluble injection

Answer 24

30-60mins

Question 25

what is peak action of soluble injection

Answer 25

1-4hr

Question 26

what is duration of soluble injection

Answer 26

upto 9hr

Question 27

types of rapid acting insulin

Answer 27

**no LAG** -lispro aspart glulisine

Question 28

when should rapid-acting injection be injected

Answer 28

immediately before meals

Question 29

what is onset of rapid-acting injection

Answer 29

<15mins

Question 30

what is duration of rapid-acting injection

Answer 30

2-5hr

Question 31

what are the types of insulin

Answer 31

-intermediate-acting insulin -long-acting insulin

Question 32

what is types of intermediate-acting insulin

Answer 32

bisphasic isophane biphasic aspart lispro (isophane inj mixed with SA insulin)

Question 33

what is onset of intermediate-acting insulin

Answer 33

1-2hr

Question 34

what is peak effect of intermediate-acting insulin

Answer 34

3-12hr

Question 35

what is duration of intermediate-acting insulin

Answer 35

11-24hr

Question 35

what are the types of long-acting insulin

Answer 35

Detemir (BD) Degludec (OD) Glargine (OD)

Question 36

what is onset of long-acting insulin

Answer 36

2-4DY to reach steady state

Question 37

what is duration of long-acting insulin

Answer 37

36hr