Management of Type 1 Flashcards
What are the 4 aims in management of type 1 DM?
- prompt diagnosis !!
- encouragement of appropriate self management skill set
- correction of acute metabolic upsets at diagnosis + thereafter
- facilitate long term health + well being
How many type 1 diabetics are diagnosed in DKA?
1 in 4 !
1 in 3 under 5yrs
3 steps to early diagnosis of type 1 DM?
THINK symptoms
TEST immediately
TELEPHONE urgently
What are the 4 Ts of type 1 DM (THINK symptoms)?
Thirsty
Tired
Thinner
Using Toilet more
What is a ‘red flag’ symptom of type 1?
Return to bedwetting or daywetting in a prev dry child
What is the immediate test for type 1 and the result in a diabetic?
Finger prick capillary blood glucose test
>11mmol/l
What 4 things should u NOT do in suspected type 1?
Request returned urine specimen
Arrange fasting BG test
Arrange OGTT
Wait for lab results
What should you request in suspected type 1?
SAME DAY review from local paediatric specialist diabetes team
What are some strategies to support people with type 1 DM?
- education
- nutrition and lifestyle management
- skills training
- insulin (analogues, pens, pumps)
What other symptoms of type 1 should u consider in children under 5?
Heavier nappies Blurred vision Candidiasis (oral/vulval) Constipation Recurring skin infection Irritability/behaviour change
What 4 things should u check before injecting insulin?
Right INSULIN
Right DOSE
Right TIME
Right WAY
What are the ways insulin can be administered and in what situations?
Injected subcutaneously (usual route) IV (illness/surgery)
Soluble insulin needs to be injected 30 mins before eating as they associate with hexamers, what type of insulin CAN be injected just before a meal?
Rapid acting analogues
What should the amount of insulin injected for meals balance?
The carbohydrate intake consumed
Name some methods of education on type 1 DM
Patient handbooks Leaflets Websites Education days Health care prof education House of Care My Diabetes My Way Insulin Pump starts
What are the 2 methods of home BG monitoring?
Finger prick capillary testing
Permanent pump
What are the 5 different insulins in terms of duration of action?
RAPID acting (lispro, aspart (analogue)) SHORT acting (soluble, actrapid, Humulin S) INTERMEDIATE acting (Isophane, insulatard, Humulinl) LONG acting (glargine (analogue), detemir, degludec) CSII (continuous sub-cutaenous insulin infusion)
What are 4 things to consider in insulin injection technique?
Needle size
Location
Rotation of injection site
Technique
What are good sites for insulin injection?
Fatty areas - buttocks, lower stomach, thighs
What does the twice daily insulin regimen involve?
Rapid acting mixed with intermediate acting
BB and BT
What does the three times daily insulin regimen involve?
Rapid mixed with intermediate BB
Rapid BT
Intermediate BBed
What does the four times daily regimen involve?
Short BB, BL, BT
Intermediate BBed or long acting at fixed time once daily
How many units of Rapid per 10g CHO?
1
What is CSII and what does it involve?
Continuous Subcutaneous Insulin Infusion
All the time there is a basal amount of insulin being delivered; this can go up or down controlled by patients
Why would patients alter their CSII levels?
Decrease when exercising
Increase when unwell
When eating carbs type in how much they are having
What is hypoglycaemia?
Any episode of low BG (<4mmol/l) with or w/o symptoms
What is required in a severe hypo (when patient is no longer able to self manage)?
Third party intervention
Give reasons for hypo
- too much insulin
- inappropriate timing of insulin
- injection site problems
- inadequate food intake/fasting
- exercise
- alcohol
Even if untreated, how do most isolated hypo episodes recover?
Spontaneously
What are the 3 categories in the Edinburgh Hypoglycaemia Scale?
Autonomic
Neuroglycopenic
General malaise
Describe the symptoms in each category of the EHS
A: sweating, palpitations, shaking, hunger
N: confusion, drowsiness, odd behaviour, speech difficulty, incoordination
GM: headache, nausea
What is inability to perceive normal warning symptoms of hypo associated with?
Recurrent severe hypo
Long duration of disease
Over tight control
Loss of sweating/tremor
All patients treated with insulin or sulphonylureas are advised to carry what with them?
Carbohydrates
What are 3 possible effects of hypo?
Coma
Hemiparesis
Seizures
What can happen is hypo is prolonged?
Neurological deficits may become permanent
What is the treatment for hypo?
15-20g simple CHO
5-7 dextrosol/4-5 glucotabs; 200ml fruit juice
If unable to take oral CHO, what is the treatment? (in hospital and out)
Out - 1mg im glucaon; GlucoGel/Dextrogel
In - 75-80ml 20% glucose of 10% glucose or 20-50mls 50% dextrose iv
What is the follow up for a hypo?
Long-acting CHO
What are symptoms of DKA?
Polyuria Polydipsia Weight loss Weakness Nausea/vomiting Abdo pain Breathlessness
What are signs of DKA?
Dry mucous membranes Sunken eyes Tachycardia Hypotension Ketotic breath Altered mental state Hypothermia
What are the initial investigations for DKA?
RAPID A, B, C IV access Vital signs Clinical assessment Full clinical examination Glucose Venous blood gas Urinalysis/blood ketones U+E, FBC Culture blood/urine ECG + cardiac monitor Consider CXR
What could cause DKA?
Infection; severe stress; insulin omission
What are some complications of DKA?
- Hyper/hypo- kalaemia
- Hypoglycaemia
- Cerebral oedema
- Aspiration pneumonia
- Arterial + venous thromboembolism
- ARDS
What is the treatment for DKA in hospital HDU?
IV saline IV insulin IV potassium in saline May need abx Consider heparin, NG tube
