d4 Flashcards
DM type 1 and 2
Type 1 Diabetes
- Auto-immune disease (Nothing is wrong with the pancreas, it is the immune system that starts the process)
- Felt to be a combination of genetics and environment
- Insulin dependent
- Life long condition
Type 2 Diabetes
- Genetic –> Environment factors also play a role (obesity, dyslipidemia, ethnicity, PCOS).
- resistant to insulin –> putting stress on the pancreas
- Can be initially treated with diet/exercise, or with oral medication and or insulin.
- Life long condition
- only 10% of people with type 2 diabetes are not obese
onset of stymtpoms T1 and T2 DM
TD1
- Polyuria
- Polydipsia
- polyphagia
- Nausea/vomiting
- Decreased energy
- Dehydration
- Pale/irritability
- UTI
- DKA
T2D
- Can look like T1D
- DKA / HHS (only 25%)
- Screening BMI > 85th % for age and sex
diet for t1 in peds
There is no “diet” for children/youth with
Nutrition requirements are the same for age matched peers
Foods to limit –> Foods high in added sugar
- juice
- Syrup
- Candy
Don’t have to avoid
- Fruit
- Yogurt
- Plain ice cream
insulin regimens BID and TID
BID
- Two injections per day
- Mix of rapid and intermediate insulin
- BG Testing 4 times per day. Before meals, before bedtime snack and if suspecting low or ketones.
TID
- Same insulins as Bid
- NPH/N moved from supper to bedtime.
- Three injections daily
- Can use Levemir at bedtime, instead of NPH/N
Advantages and disadvantages of BID/TID
Advantages
- Simple and straightforward
- Only 2-3 injections per day
- Works great for families with structured lifestyles
Disadvantages
- Fixed timing of meals
- Fixed amount of carbohydrate at each meal
- Must eat snacks to prevent lows
- Increased risk for hypoglycemia
- Intermediate insulin is outdated and difficult to titrate to meet insulin needs.
- Not a recommended regimen in peds and adults.
MDI, advantages and disadvantages
MDI
- Basal insulin (24 hr ) given once daily
- Meals and blood sugar corrections done with rapid insulin
- Corrections via sliding scale or ISF/IC
- Minimum BG testing 4 times per day or more.
MDI Advantages
- Flexibility and timing and size of meals/snacks
- More opportunities to adjust insulin with activity
- Less variability in BGs
- Less hypoglycemia
MDI Disadvantages
- More blood sugar checks
- Carb counting at every meal and snack
Intense
- Extra needles
- May need twice daily long acting insulin
- More parental involvement
Insulin to carb ratio
I:C ratio tells you how many units of insulin you need to cover a specified amount of carbohydrate
Example: If your ratio is 1:10 then you need 1 unit of insulin for every 10 grams of carbohydrate
Pump
- Uses only fast-acting insulin (NovoRapid or Humalog)
- Pump automatically delivers a basal rate of insulin –> These rates are preprogrammed and vary throughout the day and night
- Pump user can deliver extra bolus insulin to cover the carbohydrates in meals and snacks
- Pump user can deliver correction bolus for occasional high blood sugars
- Need to test a minimum 4 times per day or more.
Pump Advantages
- Different types of boluses
- Temporary basal rates
- Less injections
Pump Disadvantages
- Risk of DKA
- More trouble shooting
- Parental involvement
- More blood sugar checks
- Carb counting
insulin injections
Insulin Injections
- Cloudy insulin needs to be gently mixed,
rolled and dipped approximately 12 times.
- If using a single syringe we teach our families at Cheo to draw clear then cloudy.
- Long acting insulin (Levemir,lantus..ect) should not be mixed with other insulins.
- If using insulin pens always discard a few units prior to injection to ensure pen is working appropriately and the needle is primed.
- Families are instructed to keep insulin at room temperature as it’s more comfortable.
- Once a vial or cartridge is opened it is good for one month. If unopened it’s good till expiry date if kept refrigerated.
hypoglycemia
Hypoglycemia
- is defined as a blood glucose level below 4mmol/L
- Is usually caused by: Unplanned activity, Carbohydrates do not match the amount of insulin
How to prevent:
- Decrease insulin and/or eat extra food for exercise/activity.
- Eat all carbohydrates for which you gave insulin.
- Be accurate with carbohydrate counting and dosing insulin.
symptoms of hypoglycemia
Symptoms of Hypoglycemi
- shaky
- Fast heart rate
- Sweaty
- Dizzy or shaky
- Anxious
- Hungry
- Blurry vision
- Headache
- decreased loc
hypoglycemia treatment
sugar, maple syrup, honey, jam, rockets, giant rockets etc
for children under 5
- 5g of carbs
children 5-10
- 10 g of carbs
for children greater than 10
- 15g of carbs
hyperglycemia
Defined as a BG above target (ex: 4-8mmol/L).
Causes:
- Decreased activity.
- Insulin and carbohydrates do not match
Prevention:
- Illness management. May require more insulin.
- Accurate carb counting, timing of meals and accurate dosing.
s/s
- Dry mouth
- Drowsy
- Blurred vision
- Frequent urge to urinate
- Extreme tiredness
- Extreme thirst
DKA
dka
- Lack or no insulin is the cause of ketone production.
- Ketone is the breakdown of fat and protein cells for energy use.
- DKA is a serious condition that can lead to diabetic coma and even death.
- DKA is completely preventable in a diagnosed diabetic.
- Need to correct acidosis first, then correct BG.
DKA looks like the stomach flu.
- Abdominal cramps
- Nausea / vomiting
- Tiredness.
Can also include:
- Fast shallow breathing
- Fruity breath
- Decreased consciousness
CGM and FGM
Continuous Glucose Monitoring (CGM) and Flash Glucose Monitoring (FGM)
- Device that is worn 24/7.
- It reads interstitial fluid via sensor for sugar level.
- Very useful to get a “big picture” look at what trends.
- Useful for activity, sick days and overnight levels.
- Can be used for dosing insulin, depending on which technology.
- Can decrease the number of BG testing every day.
- DOES not replace gold standard of BG testing.
Downside
- Can lag behind true BG by 15min depending on how quick BG is rising or falling.
- Calibrations can be off.
- Can fall off.
