Type 1 Diabetes

Question 1

What is diabetes?

Answer 1

Hyperglycaemia - caused by lack of insulin or insulin resistance

Question 2

DVLA (1)

Answer 2

Inform DVLA insulin/risk of hypo (anti-diabetics)
Carry glucose meter/strips
Blood glucose >5mmol/l = FIVE to DRIVE

Question 3

DVLA (2)

Answer 3

Fasting carbohydrate e.g. coke/sugar lumps

<4mmol/l = hypo, do not drive, wait until 45 minutes after blood glucose is normal

Question 4

Alcohol:

Answer 4

Limit consumption

Mask and delay symptoms of hypo

Question 5

(OGTT)

Answer 5

Diagnose impaired glucose tolerance
Used to establish gestational diabetes
Measure blood glucose conc after fasting and then 2 hours after drinking a glucose drink

Question 6

HbA1c

Answer 6

Good indicator of glycaemic control in type 1/type 2
Monitor plasma glucose 2-3 months
Performed at any time of the day
HbA1c (mmol/mol)

Question 7

Do not use HbA1c:

Answer 7

Diagnosis:
Type 1 diabetes
Children
During pregnancy/postpartum

Question 8

HbA1c monitoring:

Answer 8

Predictor of micro/macrovascular complications

Monitor every 3-6 months (type 1/2) until stable, then every 6 months (type 2)

Question 9

Type 1

Insulin regimes to achieve optimal blood glucose levels

Answer 9

Polyuria/nocturia
Polydipsia
Random plasma glucose conc: >11mmol/l (hyper)
Weight loss
Extreme hunger
Fatigue

Question 10

When to monitor:

Answer 10

Monitor at least 4 times a day

Question 11

Target HbA1c for type 1

Answer 11

< or equal to 48mmol/mol

Question 12

On waking

Answer 12

5-7mmol/L

Question 13

Before meals

Answer 13

4-7mmol/L

Question 14

After meals

Answer 14

5-9mmol/L

Question 15

When driving

Answer 15

At least 5mmol/L

Question 16

Insulin regimes:

Answer 16

1. Basal-bolus
   (most preferred - mimics natural insulin release)

Basal - Intermediate/LA
Bolus - SA/rapid - given before meals

Question 17

Insulin regimen:

Answer 17

2. Mixed (biphasic)
   SA or RA + Intermediate insulin
   (1-3 injections per day)

Examples

• premixed analogues e.g. Novomix
• premixed human insulin e.g. Humulin M2

Question 18

Insulin regimens:

Answer 18

3. Continuous SC infusion (pump)

Reg/continuous amount of insulin

Usually RA or soluble insulin

Question 19

Recommended regimens

Answer 19

1st line
B-B
(levemir BD/lantus OD)

• if not possible offer:
  1. Biphasic
  2. Offer insulin pump for disabling hypo or high HbA1c

Question 20

Decrease insulin requirements:

Answer 20

Incurrent illness, exercise, reduce food intake, impaired renal function, endocrine disorders e.g. Addison’s

Question 21

Increase insulin requirements:

Answer 21

Stress, infection, surgical trauma

Question 22

MOA of insulin

Answer 22

Secreted by beta cells of the pancreas
Increases glucose uptake
Lowers blood glucose conc

Question 23

Sources of insulin

Answer 23

Human insulin
Analogue insulin
Animal insulin

Question 24

Admin of insulin

Answer 24

SC route = most ideal
Check inj sites for infection, swelling or bruising before admin
Inject in areas of SC fat e.g. abdomen, outer thigh, bum
Rotate sites to prevent lipohypertrophy

Question 25

Examples of soluble insulin:

act within 3-60 mins, last up to 9 hours

Answer 25

Humulin S
Actrapid
Insuman

IV*, SC and IM
* = in emergencies e.g. DKA

Question 26

Examples of Intermediate insulins

act within 1-2 hours, can last up to 24 hours

Answer 26

Isophane

Humulin I

Question 27

Examples of LA insulin

lasts up to 36 hours

Answer 27

Detemir (Levemir) - once or twice daily inj
Degludec (Tresiba)
Glargine (Lantus, Toujeo)

Question 28

Examples of RA analogues:

act within 15 mins, last for 2-5 hours

Answer 28

Lispro (humalog)
Aspart (novorapid/fiasp)
Gluisine (apidra)