Diabetes Type 1

Question 1

What is type 1 diabetes?

Answer 1

when the body is unable to make insulin.
An absolute insulin deficiency causing persistent hyperglycaemia (high blood sugars). It can lead to abnormal carbohydrate, protein and fat metabolism

Question 2

What causes type 1 diabetes?

Answer 2

Autoimmune destruction of b cells in the Islets of Langerhans which make insulin. As well as genetic and environmental influences

Question 3

what are some of the ways type 1 diabetes can be diagnosed?

Answer 3

Low BMI, rapid weight loss, age, family history

Question 4

What are the signs and symptoms of type 1 diabetes?

Answer 4

4Ts – Thirst (polydipsia), extreme tiredness, loss of weight (thinner), toilet - frequent urine ((polyuria) and unexplained frequent UTIs

Question 5

What would CBG levels indicate for a person with type 1 diabetes?

Answer 5

Random CBG would be greater than 11mmol

Fasting CBG would be greater than 7mmol

Cbg - Capillary blood glucose

Question 6

What is a healthy CBG target for those with diabetes?

Answer 6

4-7mmol/l

Question 7

What are the types of insulin available for treatment?

Answer 7

rapid-acting insulins

short-acting

Long-acting insulins

Intermediate

Newer insulins

Question 8

Assess the risks and benefits of newer insulins

Answer 8

Higher strength insulin e.g. (U200) which means
200units per ml compared to standard insulin which
has 100units/ml
 Good for patients who require large doses
 Toujeo (insulin glargine) U300 (300units/ml)
 Tresiba (insulin degludec)
 Ultra long acting insulin (lasts up to 42hours)
 Reduced risks of nocturnal hypoglycaemia
 Minimum of 8 hours should be ensured between
doses
 The pen device shows the number of units that will
be injected, irrespective of strength.

Question 9

What are some of the issues with prescribing insulin?

Answer 9

high risk drug due to prescribing, administration and dispensing errors

Question 10

What is hypoglycaemia?

Answer 10

Hypoglycaemia – typically a capillary blood glucose level of 4mmol/l or less (low blood glucose levels)

Question 11

What are the signs and symptoms of hypoglycaemia?

Answer 11

Extreme tiredness

Dizziness

Blurred vision

Headaches

Mood changes

Sweating

Trembling

Hunger

Question 12

What are the different levels of hypoglycaemia? And how can each stage be treated?

Answer 12

MILD - conscious and able to self treat
* Encourage uptake of rapid acting glucose, provided they can do so without choking.
- Oral sugary liquids e.g. 50-100ml fruit juice/ordinary cola (Not diet).
- 3-4 dextrose tablets (Lucozade Energy/Glucotabs).
* Follow up with a substantial snack/meal to prevent blood glucose levels from falling again.
- Chocolate and milk are NOT recommended.
* Check [CBG] regularly to ensure recovery.

MODERATE – conscious but unable to self treat
* The person must be able to swallow safely.
* Administer GlucoGel OR jam inside cheeks, massage gently.
* Follow with a substantial snack/meal to prevent blood glucose levels falling.
* Check [CBG] levels regularly to ensure recovery.

SEVERE
- unconscious… needs help
 Treatment is URGENT
 Place in the recovery position.
 Ensure clear airway.
 Administer Glucagon 0.5-1 mg intramuscularly.
 Intravenous glucose may also be administered
 When able to swallow offer a substantial snack/meal.
 Check [CBG] levels to ensure recovery.
 If two or more severe hypos in the last
2 years + impaired awareness of hypo
=> Consider islet transplant

Question 13

How can one avoid hypoglycaemia?

Answer 13

eat regularly
keep to regular alcohol limits and do not drink on an empty stomach
Take insulin as recommended

Question 14

How is insulin stored?

Answer 14

Store unopen supplies in a fridge
insulin in use can be get at room temp but avoid direct sunlight and heat
Dispose needles into sharps bin

Question 15

What are the counselling points for the prevention of hypoglycaemia?

Answer 15

Discuss likely causes e.g. missing meals or antidiabetic medication
* Insulin passports / patient information leaflets.
* Encourage to report or document hypoglycaemia.
* Emphasise importance of carrying glucose to enable them to treat symptoms
immediately.
* Confirm blood glucose meter is working correctly and the person knows how to interpret results.
* Driving issues, e.g. plan long journeys,
* Written information to back up verbal discussions with resources for further contact or information e.g. websites, telephone numbers.
* Educate family/carers about treatment of hypoglycaemia.

Question 16

What is diabetic ketoacidosis?

Answer 16

DKA – is due to a lack of insulin and the body breaks down fat in an abnormal way which causes an electrolyte imbalance

Glucose is not able to be used = body looks for alternate energy =
lipolysis = ketone production (ketonaemia >3mmol/L)
Cells still require glucose = hepatic over production of glucose =
hyperglycaemia (>11mmol/L)
=dehydration and loss of electrolytes (Na+ and K+)
Intracellular K+ exchanged for H+ ions = acidosis (bicarbonate
<15mmol/L and/or pH <7.3)

A MEDICAL EMERGENCY
High mortality rate if it is not managed promptly.

Question 17

What are the signs and symptoms of DKA?

Answer 17

• Fatigue
  Nausea & Vomiting
  ‘Pear drop’ breath
  Tachycardia
  Hyperventilation - Kussmaul (trying to remove excess CO2 and acid)
  Drowsiness and confusion
  Coma (10%)
  Hyperglycaemia
  Dehydration
  Polydipsia
  Polyuria
  Ketones detected in urine

Question 18

What are the causes of DKA?

Answer 18

40% of cases - no identifiable cause
* New presentation of diabetes type 1.
* Insulin management errors
* Omission of insulin
* Compliance - check history
* Equipment- faulty insulin pen/pump
* Concurrent illness or stress
* Infection – e.g. UTI, gastroenteritis
* Secondary causes e.g. MI.

Question 19

How can DKA be managed?

Answer 19

Rehydration with intravenous fluids and monitor BP (systolic no less than
90mmHg).
* Electrolyte replacement, including K+ (KCl in fluids and monitor plasma
K+)
* Soluble insulin given intravenously to achieve and maintain adequate
plasma-insulin concentration (50 UNITS/50ml NaCl FRIII or VRIII).
* Treatment of underlying cause e.g. infection.
* Avoid sodium bicarbonate as it may cause cerebral oedema.
* Plan for the transfer back to subcutaneous insulin

Question 20

What are the sick day rules for diabetes?

Answer 20

Clear guidance for the management of diabetes during periods of illness.
 Never stop or omit insulin.
 Monitor blood glucose more closely and frequently
 Check for blood ketone levels regardless of blood glucose
 Keep well hydrated
 Treat the underlying condition ?illness/flu

Question 21

When do we give patients variable rate intravenous insulin infusion?

Answer 21

For patients unable to take oral fluid/food and for whom adjustment
of their own insulin regimen is not possible.
 Aim: normoglycaemia
 Use of IV fluids with VRIII is to avoid hypoglycaemia by providing
substrate (dextrose) at a steady rate for the insulin infusion and to
maintain fluid and electrolyte balance.