Lecture 16 Management of Type 1 Diabetes

Question 1

What steps are involved in making an early diagnosis

Answer 1

THINK- Symptoms
•	Thirsty
•	Thinner
•	Tired
•	Using the toilet more

Question 2

In children under 5 what other symptoms can be used to diagnose

Answer 2

• Heavier than usual nappies
• Blurred vision
• Candidiasis (oral, vulval)
• Recurring skin infections
• Irritability, behaviour change

Question 3

Whats the first line management if type 1 diabetes is suspected

Answer 3

• Finger prick capillary glucose test
• If result >11mmol/l
Telephone- Urgently
• Contact local specialist for same day review

Question 4

What are the symptoms of DKA

Answer 4

• Nausea & Vomiting
• Abdominal pain
• Sweet smelling, ketotic breath
• Drowsiness
• Rapid, deep sighing respiration
• Coma

Question 5

Strategies to support people with type 1 diabetes

Answer 5

Education
Nutrition and lifestyle management
Skills training
Insulin- analogues, pens, pumps

Question 6

Describe the sick day rule for type 1 diabetes

Answer 6

Insulin should never be stopped
May need to increase insulin dose
Blood glucose levels should be checked at least every 2-4 hours
Drink sugar free fluids to avoid dehydration
Aim for blood glucose of 6-10mmol/L

Question 7

Why does insulin need to be given 30 minutes before eating

Answer 7

In subcutaneous fat the insulin molecule has the tendency to self-associate into hexamers. Hexamers need to dissociate into monomer before absorption through capillary bed

Question 8

Do rapid acting analogues need to be administered 30 minutes before eating

Answer 8

No

Question 9

Name methods of education for type 1 diabetics

Answer 9

Any of these:
•	Patient handbooks
•	Leaflets
•	Websites
•	Pregnancy
•	Insulin pump starts
•	Rolling programs/Topics
•	Education days
•	CGM starts
•	Apps CHO/fitness
•	Health care professional education
•	House of care
•	Online
•	My Diabetes My Way
•	Think Check Act
•	3rd sector 
•	Set curriculum (DIANE)- Diabetes Insulin Adjustment for Normal eating Course

Question 10

Name rapid acting insulin

Answer 10

– Insulin lispro

– Insulin aspart

Question 11

Name short acting insulin

Answer 11

– Soluble insulin
– Actrapid
– Humulin S

Question 12

Name immediate acting insulin

Answer 12

– Glargine
– Detemir
– Degludec

Question 13

Name long acting insulin

Answer 13

– Levemir

Question 14

Whats another form of insulin

Answer 14

• Continuous sub cutaneous insulin infusion (CSII)

Question 15

Describe the twice daily insulin regimen

Answer 15

• Rapid acting mixed with intermediate acting

* Before breakfast (BB) and evening meal (BT)

Question 16

Describe the three times daily insulin routine

Answer 16

• Rapid acting mixed with intermediate acting BB
• Rapid acting BT
• Intermediate acting at bedtime BBed

Question 17

Describe the four times daily insulin routine

Answer 17

• Short acting BB BL BT

* Intermediate BBed or long acting insulin at a fixed time once daily

Question 18

What are the causes of hypoglycaemia

Answer 18

• Too little of wrong type of food
• Activity during/after
• Insulin dose, injection technique
• Alcohol

Question 19

What groups are at risk of hypoglycaemia

Answer 19

• Tight glycaemic control
• Impaired awareness
• Cognitive impairment
• Extremes of age
• Malabsorption/gastroparesis
• Abrupt steroid withdrawal
• Coeliac disease
• Renal/hepatic impairment
• Pancreatectomy
• Pregnancy

Question 20

What are autonomic features of hypoglycaemia in the Edinburgh scale

Answer 20

Sweating
Palpitations
Shaking
Hunger

Question 21

What are neuroglycopenic features of hypoglycaemia in the Edinburgh scale

Answer 21

Confusion
Drowsiness
Odd behaviour
Speech difficulty
Incoordination

Question 22

How is hypoglycaemia treated

Answer 22

15-20g of simple CHO, dextrosol, Glucotabs. Glucogel/Dextrogel or IV dextrose

Question 23

What should be included in a hypobox

Answer 23

• Fruit juice
• Dextro energy
• Glucogel
• 20% or 50% dextrose
• Hypo management protocol

Question 24

How can hypoglycaemia be avoided

Answer 24

• Blood glucose monitoring
• Rotate and check injection sites
• Review snack and diet- carb counting
Change insulin regimen

Question 25

What are the signs of hypoglycaemia

Answer 25

• Polyuria
• Polydipsia
• Weight loss
• Weakness
• Nausea/vomiting
• Abdo pain
• Breathlessness

Question 26

What are the signs of hypoglycaemia

Answer 26

• Dry mucus membranes
• Sunken eyes
• Tachycardia
• Hypotension
• Ketotic breath
• Kussmaul resp.
• Altered mental state

Question 27

Initial investigations for DKA

Answer 27

Rapid ABC
IV access
Vital signs
Glucose
Venous blood gas
U&Es
Culture blood/urine
ECG + cardiac monitor
Consider CXR

Question 28

What are the complications of DKA

Answer 28

•	Hyperglycaemia
•	Hypoglycaemia
–	Rebound ketosis
–	Arrhythmias
–	Acute brain injury
•	Cerebral oedema
–	Children more susceptible 
•	Aspiration pneumonia
•	Arterial and venous thromboembolism
•	ARDS

Question 29

How do you treat DJA

Answer 29

• Measure glucose/U&Es/Ketones/Bicarbonate/arterial blood gas
• Give IV saline
• Give IV insulin (drives glucose and potassium into cells)
• Give IV potassium in saline
• May need antibiotics
• Consider heparin, NG tube