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year 2 endocrine - Robbie > Management of Diabetes - Type 1 Diabetes Mellitus > Flashcards

Management of Diabetes - Type 1 Diabetes Mellitus Flashcards

1
Q

When living with a long term condition, how many hours a year are spent slef managing and how many are spent with a NHS professional?

A
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2
Q

what is involved in person centred care?

A
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3
Q

what are the aims of management of type 1 diabetes mellitus?

A

Prompt diagnosis

Self management skill set

Acute metabolic upsets at diagnosis and thereafter

Facilitate long term health and well being

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4
Q

why is an early diagnosis important?

A

Scotland has 5th highest incidence of Type 1 Diabetes in the world

In Scotland 300 children under the age of 15 years are diagnosed with Type 1 Diabetes annually

1 in 4 are diagnosed in DKA, rising to 1 in 3 under the age of 5 years

In the UK 10 children die and 10 children suffer permanent neurological disability

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5
Q

what are things to look out for in a possible diagnosis of diabetes?

A

thinner

thirsty

tired

using toliet more

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6
Q

symtpoms of diabetes can be due to what 2 things?

A

blood glucose and blood ketone

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7
Q

What is the benefit of managing HbA1c well at the starts?

A

Manage HbA1c good at the start and then this will have a legacy effect and work out better in the future

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8
Q

what are some current strategies in place to support people with type 1 diabetes?

A

Education:

  • Team based DSN, practice nurse, dietitian, podiatrist, doctors
  • Structured education e.g. DIANE, Dose Adjustment For Normal Eating
  • Person with diabetes is main team member

Nutrition and Lifestyle management e.g. CHO counting, physical exercise

Skills training e.g. Home blood glucose monitoring, injection technique, hypos, sick day rules

Insulin- analogues, pens, pumps

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9
Q

What are the different types of insulin you can get and their duration?

A

Rapid acting insulins eg insulin lispro*, insulin aspart* (Humalog®,Novorapid®,Apidra®)

Short acting insulins eg soluble insulin, actrapid, Humulin S.

Intermediate acting insulins eg Isophane insulin;insulatard,HumulinI.

Long acting insulins eg glargine*, detemir*, degludec

Continuous sub cutaneous insulin infusion (CSII)

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10
Q

What do you need to check before you inject insulin?

A

Right insulin – check the name

Right dose – check strength and how much insulin to give. Check the numbers very carefully

Right time – with food? At bedtime?

Right way – via syringe, pen or pump?

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11
Q

Why is insulin taken IV and subcutaneously and not orally?

A

Insulin is a polypeptide which is inactivated by the gastrointestinal tract therefore it needs to be injected subcutaneously (usual route) or intravenously (e.g. during illness or surgery)

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12
Q

What happens to the insulin in the subcutaneous fat?

A

In the subcutaneous fat the Insulin molecule in solution has a tendency to self-associate into hexamers

Hexamers need to dissociate into monomers before absorption through the capillary bed. Thus soluble insulin is given 30 mins before eating

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13
Q

why can rapid acting analogues be injected?

A

Rapid acting analogues do not associate and can be injected just before eating

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14
Q

Changing the structure of insulin or binding it to other molecules will change the rate of _________

A

absorption

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15
Q

The amount of insulin injected for meals should balance the ___________ intake consumed

A

carbohydrate

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16
Q

What do Insulin Therapy Regimens allow?

A

Suitable for a flexible lifestyle

Better for shift workers

Rapid (Short) acting insulin to cover CHO at meals 1 unit per 10g CHO

Basal long acting insulin as background

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17
Q

Current Insulin Regimens:

Twice daily

A

Rapid acting mixed with intermediate acting

Before breakfast (BB) and evening meal (BT)

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18
Q

Current Insulin Regimens:

Three times daily

A

Rapid acting mixed with intermediate acting BB

Rapid acting BT

intermediate acting at bedtime BBed

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19
Q

Current Insulin Regimens:

Four times daily

A

Short acting BB BL BT

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

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20
Q

Insulin administration to _________ ___

A

subcutaneous fat

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21
Q

Insulin administration to subcutaneous fat requires the correct what?

A

Needle size

Location

Rotation

Technique

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22
Q

What things may be used to educate a patient?

A

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

On Line

My Diabetes My Way

Think Check Act

3rd Sector

23
Q

What are osme examples of when you would assess blood glucose control - home blood glucose monitoring and ketone testing

A

to adjust insulin dose, prior to driving, tighten control

24
Q

What is this shown?

A

Continuous Subcutaneous Insulin Infusion (CSII)

25
Q

what are some adjustments that may need to be made for someone living with type 1 diabetes?

A

Lifestyle

Exercise

Driving

Alcohol

Conception

Drugs

Holidays

Employment

26
Q

what are osme emergencies that may occur due to type 1 diabetes?

A

Hyperglycaemia - Diabetic Ketoacidosis

Hypoglycaemia

27
Q

WHat level of BG is hypoglycaemia?

A

Low blood glucose level <4mmol/l

28
Q

Reasons for hypoglycaemia - Imbalance between what?

A

Food - too little/wrong type

Activity - during/after

Insulin (or some Oral Hypoglycaemics) - dose, injection technique

29
Q

What are hypoglycaemia causes?

A

Too much insulin/SU

Inappropriate timing of insulin/SU

Injection site problems

Inadequate food intake/fasting

Exercise

Alcohol

30
Q

what are the groups at risk of hypoglycaemia?

A

Tight glycaemic control

Impaired awareness

Cognitive impairment

Extremes of age

Malabsorption/gastroparesis

Hypoadrenalism/abrupt steroid withdrawal

Coeliac disease

Renal/hepatic impairment

Pancreatectomy

Pregnancy

31
Q

Patients should be advised about how to what?

A

avoid, recognise, and treat hypoglycaemia

32
Q

Loss of warnings of hypoglycaemia is associated with what?

A

recurrent severe hypoglycaemia

long duration of disease

over tight control

loss of sweating/tremor

pregnancy

33
Q

what is the treatment of hypoglycaemia?

A

All patients treated with insulin or sulphonylureas should be advised to carry carbohydrate with them

34
Q

hypoglycaemia can cause what?

A

Hypoglycaemia can cause coma, hemiparesis and seizures

35
Q

Prolonged hypoglycaemia cna lead to what?

A

If the hypoglycaemia is prolonged the neurological deficits may become permanent

36
Q

what is this

A

hpyo box

37
Q

how do you avoid hypoglycaemia in insulin treated diabetes?

A

Blood glucose monitoring

Rotate and check injection sites

Review snacks and diet –Carb counting

Consider a change of insulin regimen eg basal bolus, CSII

Avoid low glucose -“4 is the floor” (7 at bedtime & 5 to drive)

Alter insulin before and after exercise

DVLA

38
Q

what should you do when you blood ketones are at each different levels?

A
39
Q

what are the risk factors for DKA?

A

Known T1DM, inadequate insulin, infection, other precipitant

40
Q

what are the symptoms of DKA?

A
  • Polyuria
  • Polydipsia
  • Weight loss
  • Weakness
  • Nausea/vomiting
  • Abdo pain
  • Breathlessness
41
Q

What are the signs of DKA?

A
  • Dry mucus membranes
  • Sunken eyes
  • Tachycardia
  • Hypotension
  • Ketotic breath
  • Kussmaul resp. (Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure)
  • Altered mental state
  • Hypothermia
42
Q

how to treat an acute illness in insulin treated patients?

A

NEVER stop insulin

Increase/adjust insulin dose according to blood glucose

perform more frequent blood glucose checks

check urine or blood for ketones

carbohydrate intake must be maintained by fluids (eg fruit juice) if unable to tolerate food

43
Q

study this summary diagram

A
44
Q

Diabetic ketoacidosis = _______ + _______ + ______

A

Diabetic ketoacidosis = Glucose + Ketones + Acidosis

45
Q

Diabetic ketoacidosis caues what?

A

Dehydrated

Thirsty

Abdominal pain

Acidotic breathing (Kussmauls)

Acetone on breath

Tachycardic and low BP

46
Q

what investigations are done for DKA?

A
47
Q

what are some complications of DKA?

A

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

48
Q

How can you facilitate long term health and well being?

A

Optimal blood glucose control (HbA1c):

  • to reduce microvascular disease e.g. retinopathy
  • to improve pregnancy outcome

Optimal blood pressure control - to reduce nephropathy

Manage cardiovascular risk factors - e.g. smoking, cholesterol

Screen for early detection of complications - feet, eyes & kidneys

49
Q

what do sensor augmented pumps do?

A

Full integration of insulin delivery with real time blood glucose monitoring – CLOSED LOOP

Potential to act like an artificial pancreas

50
Q

Current: Type 1 diabetes care

A

Possible Vision Type 1 Diabetes Care

51
Q

how do insulin pumps work?

A
52
Q

how does an infusion set work?

A
53
Q

what is the insulin reservoir?

A
54
Q

what are the advantages and disadvantages of an insulin pump?

A

year 2 endocrine - Robbie (28 decks)

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