Type 1 Diabetes Masterclass Flashcards
What blood glucose level should people with type 1 diabetes aim for before driving, and why?
They should aim for at least 5 mmol/L before driving to reduce the risk of hypoglycaemia while on the road, which can impair driving ability and lead to accidents.
What steps should be taken if a driver with type 1 diabetes experiences hypoglycaemia while driving?
Stop in a safe place, turn off the engine, move from the driver’s seat, take a fast-acting carbohydrate, and wait at least 45 minutes after blood glucose normalises before resuming driving.
When must a person with type 1 diabetes notify the DVLA about their condition?
They must notify the DVLA upon diagnosis and when starting insulin therapy. It is a legal obligation, and failure to do so may result in a £1000 fine or prosecution if involved in an accident.
What is the difference between Group 1 and Group 2 DVLA licensing requirements for people on insulin therapy?
Group 1 (cars/motorcycles): Licensed for 1–3 years, 1 severe hypo allowed if >3 months ago, regular glucose checks.
Group 2 (lorries/buses): Annual review, no severe hypos in past 12 months, memory-enabled glucose meter required, stricter monitoring.
What is the advice for children and young people with type 1 diabetes regarding fasting during Ramadan?
Strongly advised not to fast due to high risks of hypoglycaemia and diabetic ketoacidosis (DKA), which can be life-threatening.
What medical assessments should be completed before a person with type 1 diabetes fasts during Ramadan?
A pre-Ramadan assessment (1–2 months before) should include checks on glucose control, blood pressure, lipid profile, and necessary insulin regimen adjustments.
What should a person with type 1 diabetes do if their blood glucose falls below 3.5 mmol/L while fasting?
They must immediately break the fast, as continuing could result in severe hypoglycaemia.
What precautions should a person with type 1 diabetes take when travelling abroad?
Carry insulin and spares in hand luggage.
Take a medical letter for airport/customs.
Prepare for time zone changes (if >4 hours, consult diabetes team).
Carry hypo treatments and identification.
What advice should be given regarding alcohol intake in type 1 diabetes?
Alcohol increases the risk of delayed hypoglycaemia, especially overnight. People should limit intake, avoid drinking on an empty stomach, and always have a carbohydrate snack.
What is the onset and duration of rapid-acting insulin?
Onset ~15 mins, duration 2–5 hours. Examples: insulin lispro, insulin aspart.
How does short-acting insulin behave?
Onset 30–60 mins, duration up to 8 hours. Examples: Actrapid®, Humulin S®.
What’s the onset and duration of intermediate-acting insulin?
Onset 1–2 hours, duration 11–24 hours. Examples: Humulin I®, Insuman Basal®.
What are characteristics of long-acting insulin?
Provides up to 24 hours of coverage and reaches steady-state in 2–4 days. Examples: glargine, detemir, degludec.
What are high-strength insulins used for?
For high-dose users, with >100 units/mL. Examples: Toujeo®, Tresiba® 200 U/mL.
What are biosimilar insulins?
Biological copies of original insulins with comparable efficacy and safety (e.g. Abasaglar®).
What is the first-line insulin regimen for adults with type 1 diabetes?
Multiple Daily Injections (MDI) using a basal-bolus approach.
What’s the preferred basal insulin in adults with type 1 diabetes?
Twice-daily insulin detemir is preferred; glargine or once-daily detemir if unsuitable.
What type of bolus insulin is recommended before meals?
Rapid-acting analogues, such as lispro or aspart.
What is the mixed (biphasic) insulin regimen?
1–3 daily injections of pre-mixed short-/rapid-acting and intermediate-acting insulin.
When should insulin pump therapy be considered in adults?
For disabling hypoglycaemia or HbA1c ≥ 69 mmol/mol despite intensive MDI.
What is the first-line insulin regimen for children and young people?
Basal-bolus MDI regimen from diagnosis, with pre-meal rapid-acting analogues.
WHich insulins have to be taken before meals and how long before ?
Rapid-acting analogues - Insulin lispro, insulin aspart, insulin glulisine- Ideally 0–15 minutes before meals
Short-acting (regular) Actrapid®, Humulin S® - 30 minutes before meals
What is the purpose of a basal-bolus regimen?
To mimic natural insulin secretion—basal for background control, bolus for meals.
What are the two components of biphasic (mixed) insulin?
A short-/rapid-acting component and an intermediate-acting component.
