Type 1 Diabetes - Management Flashcards
(32 cards)
What is the mainstay of management of type I diabetes?
Insulin therapy - always indicated in a patient who has been in ketoacidosis, and is usually indicated in lean patients who present under the age of 40 years.
What are the main types of insulin regimens used in those with type I diabetes?
- Basal Bolus
- Twice Daily mix
- Three times daily
- Subcutaneous continuous insulin infusion
What is the premise behind the basal bolus regimen?
- Rapid (or short) acting insulin to cover CHO at meals
- Basal long acting insulin as background
What insulins are used in a basal bolus regimen?
Long-acting insulin
- Levemir
- Lantus
Rapid acting insulin
- Novorapid
- Humalog
What is a Twice daily mix therapy?
- Rapid acting mixed with intermediate acting insulin
- Before breakfast (BB) and evening meal (BT)
What insulins are used in the twice daily mix regimen?
- Novomix 30
- Humalog Mix 25
How is insulin administered?
Subcutaneous injection
Why is it difficult to establish insulin response similar to normal physiological response in someone with diabetes?
- Insulin is secreted directly into the portal circulation and reaches the liver in high concentration in normality - Insulin-treated patients therefore have lower portal levels of insulin and higher systemic levels relative to the physiological situation.
- Subcut insulin takes 60–90 min to achieve peak plasma levels
- The absorption of subcut insulin into the circulation is variable
- Insulin invariably peaks and declines in people with diabetes
What is important to educate a patient about when starting them on insulin?
- Bloog glucose monitoring
- Injection technique and complications
- Guidance on adjusting dosages
- DKA
- Hypoglycaemia Awareness
- Carb counting
What is important to educate the patient on regarding injection site?
- Rotate injection sites regularly
- Be aware of lipohypertrophy
What is three times daily mix regimen for treating diabetes?
Mix of short and intermediate acting before breakfast, short acting before tea and intermediate acting at bedtime
What are the benefits of basal bolus regimen?
- Suitable for a flexible lifestyle
- Better for shift workers
What are the benefits of a twice daily mix regimen for treating diabetes?
- Works best if lifestyle is fixed with regular meals
- Minimises insulin injections
What are the benefits of continuous insulin pumps?
Particularly useful in the overnight period, since the basal overnight infusion rate can be programmed to fit each patient’s needs.
When would you consider givign someone an insulin infusion pump?
- Disabling hypoglycaemia
- Failure to meet HbA1c target
What are the risks of using a insulin infusion pump?
- Skin infections
- DKA - if pump is blocked
- Obsessive glucose control
What are the main sick day rules with regards to insulin therapy?
- Avoid stopping insulin during acute illness - often increases insulin requirements despite reduced food intake
- Check BG >/= 4 times daily - if glucose increasing, increase insulin
- Check for ketones - admit if vomiting, dehydration, ketotic, a child or pregnant
What issue can long acting insulins help deal with?
Nocturnal hypoglycaemia
What is the following?
Lipohypertrophy
What are examples of long-acting insulins?
- Levemir
- Lantus
What are examples of Intermediate acting insulins?
- Insulatard
- Humulin I
- Novomix - Biphasic
- Humalog Mix - Biphasic
What are examples of rapid-acting insulins?
- Novorapid
- Humalog
- Apidra
What are examples of short-acting insulins?
- Actrapid
- Humulin S
When should rapid acting insulins be taken?
Immediately before, with or directly after a meal
