Management of Diabetes C - Type 1 Diabetes Mellitus

Question 1

what are the 4 symptoms of diabetes?

Answer 1

toilet
thirsty
tired
thinner

Question 2

how is insulin injected?

Answer 2

subcutaneously or intravenously

Question 3

what are the type of insulins?

Answer 3

rapid acting
short acting
intermediate acting
long acting

Question 4

what are the current insulin regimes?

Answer 4

Twice daily 
Rapid acting mixed with intermediate acting 
Before breakfast (BB) and evening meal (BT)

Three times daily
Rapid acting mixed with intermediate acting BB
Rapid acting BT
intermediate acting at bedtime BBed

Four times daily
Short acting BB BL BT
Intermediate BBed or long acting insulin at a fixed time once daily

Question 5

what are the reasons for hypoglycaemia?

Answer 5

imbalance between:
Food
too little / wrong type
Activity
during /after
Insulin (or some Oral Hypoglycaemics)
dose, injection technique

Question 6

what are the causes of hypoglycaemia?

Answer 6

Too much insulin/SU
Inappropriate timing of insulin/SU
Injection site problems
Inadequate food intake/fasting
Exercise
Alcohol

Question 7

who are the groups at risk of hypoglycaemia?

Answer 7

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

Question 8

what are the symptoms of hypoglycaemia?

Answer 8

sweating
palps
shaking 
hunger
confusion
drowsiness
odd behaviour
headache
nausea

Question 9

what is the treatment of hypoglycaemia?

Answer 9

All patients treated with insulin or sulphonylureas should be advised to carry carbohydrate with them.
Hypoglycaemia can cause coma, hemiparesis and seizures.
If the hypoglycaemia is prolonged the
neurological deficits may become permanent.

Question 10

what is the driving regulations with hypoglycaemia?

Answer 10

Patients should be advised to check their blood glucose before/within 2 hours of driving and during long car journeys and should always carry carbohydrate in the car.
No awareness then no driving
No more than one episode of severe hypo (Group 1) in a year

Question 11

what are the risk factors for type 1

Answer 11

Known T1DM, inadequate insulin, infection, other precipitant

Question 12

what are the symptoms of type 1

Answer 12

Polyuria
Polydipsia
Weight loss
Weakness
Nausea/vomiting
Abdo pain
Breathlessness

Question 13

what are the signs of type 1

Answer 13

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

Question 14

what are the symptons of diabetic ketoacidosis?

Answer 14

Dehydrated
Thirsty
Abdominal pain
Acidotic breathing (Kussmauls)
Acetone on breath
Tachycardic and low BP

Question 15

whatare the investigations of type 1 DM

Answer 15

Rapid A,B,C
i.v. access 
Vital signs
Clinical assessment
Full clinical examination

INVESTIGATIONS
Glucose
Venous blood gas
Urinalysis/Blood ketones
U+E, FBC
Culture blood/urine
ECG + cardiac monitor
Consider CXR

Question 16

what are the complications of DKA

Answer 16

Hyper and hypokalaemia
Hypoglycaemia
Rebound ketosis
Arrhythmias
Acute brain injury
Cerebral oedema
Children more susceptible
70-80% diabetes related deaths in children <12
Aspiration pneumonia
Arterial and venous thromboembolism
ARDS

Question 17

how do you treat DKA?

Answer 17

Measure glucose / U and E’s / ketones / bicarbonate / arterial blood gas
Give iv saline (5 l in 24 hours)
Give iv insulin (drives glucose and potassium into cells)
Give iv potassium in saline