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*Diabetes & Endocrinology > Management of Type 1 > Flashcards

Management of Type 1 Flashcards

1
Q

What are the 4 aims in management of type 1 DM?

A
  • prompt diagnosis !!
  • encouragement of appropriate self management skill set
  • correction of acute metabolic upsets at diagnosis + thereafter
  • facilitate long term health + well being
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2
Q

How many type 1 diabetics are diagnosed in DKA?

A

1 in 4 !

1 in 3 under 5yrs

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3
Q

3 steps to early diagnosis of type 1 DM?

A

THINK symptoms
TEST immediately
TELEPHONE urgently

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4
Q

What are the 4 Ts of type 1 DM (THINK symptoms)?

A

Thirsty
Tired
Thinner
Using Toilet more

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5
Q

What is a ‘red flag’ symptom of type 1?

A

Return to bedwetting or daywetting in a prev dry child

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6
Q

What is the immediate test for type 1 and the result in a diabetic?

A

Finger prick capillary blood glucose test

>11mmol/l

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7
Q

What 4 things should u NOT do in suspected type 1?

A

Request returned urine specimen
Arrange fasting BG test
Arrange OGTT
Wait for lab results

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8
Q

What should you request in suspected type 1?

A

SAME DAY review from local paediatric specialist diabetes team

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9
Q

What are some strategies to support people with type 1 DM?

A
  • education
  • nutrition and lifestyle management
  • skills training
  • insulin (analogues, pens, pumps)
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10
Q

What other symptoms of type 1 should u consider in children under 5?

A 
Heavier nappies
Blurred vision 
Candidiasis (oral/vulval)
Constipation 
Recurring skin infection 
Irritability/behaviour change
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11
Q

What 4 things should u check before injecting insulin?

A

Right INSULIN
Right DOSE
Right TIME
Right WAY

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12
Q

What are the ways insulin can be administered and in what situations?

A 
Injected subcutaneously (usual route)
IV (illness/surgery)
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13
Q

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?

A

Rapid acting analogues

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14
Q

What should the amount of insulin injected for meals balance?

A

The carbohydrate intake consumed

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15
Q

Name some methods of education on type 1 DM

A 
Patient handbooks
Leaflets
Websites
Education days
Health care prof education 
House of Care
My Diabetes My Way
Insulin Pump starts
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16
Q

What are the 2 methods of home BG monitoring?

A

Finger prick capillary testing

Permanent pump

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17
Q

What are the 5 different insulins in terms of duration of action?

A 
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)
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18
Q

What are 4 things to consider in insulin injection technique?

A

Needle size
Location
Rotation of injection site
Technique

19
Q

What are good sites for insulin injection?

A

Fatty areas - buttocks, lower stomach, thighs

20
Q

What does the twice daily insulin regimen involve?

A

Rapid acting mixed with intermediate acting

BB and BT

21
Q

What does the three times daily insulin regimen involve?

A

Rapid mixed with intermediate BB
Rapid BT
Intermediate BBed

22
Q

What does the four times daily regimen involve?

A

Short BB, BL, BT

Intermediate BBed or long acting at fixed time once daily

23
Q

How many units of Rapid per 10g CHO?

A

1

24
Q

What is CSII and what does it involve?

A

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

25
Q

Why would patients alter their CSII levels?

A

Decrease when exercising
Increase when unwell
When eating carbs type in how much they are having

26
Q

What is hypoglycaemia?

A

Any episode of low BG (<4mmol/l) with or w/o symptoms

27
Q

What is required in a severe hypo (when patient is no longer able to self manage)?

A

Third party intervention

28
Q

Give reasons for hypo

A
  • too much insulin
  • inappropriate timing of insulin
  • injection site problems
  • inadequate food intake/fasting
  • exercise
  • alcohol
29
Q

Even if untreated, how do most isolated hypo episodes recover?

A

Spontaneously

30
Q

What are the 3 categories in the Edinburgh Hypoglycaemia Scale?

A

Autonomic
Neuroglycopenic
General malaise

31
Q

Describe the symptoms in each category of the EHS

A

A: sweating, palpitations, shaking, hunger
N: confusion, drowsiness, odd behaviour, speech difficulty, incoordination
GM: headache, nausea

32
Q

What is inability to perceive normal warning symptoms of hypo associated with?

A

Recurrent severe hypo
Long duration of disease
Over tight control
Loss of sweating/tremor

33
Q

All patients treated with insulin or sulphonylureas are advised to carry what with them?

A

Carbohydrates

34
Q

What are 3 possible effects of hypo?

A

Coma
Hemiparesis
Seizures

35
Q

What can happen is hypo is prolonged?

A

Neurological deficits may become permanent

36
Q

What is the treatment for hypo?

A

15-20g simple CHO

5-7 dextrosol/4-5 glucotabs; 200ml fruit juice

37
Q

If unable to take oral CHO, what is the treatment? (in hospital and out)

A

Out - 1mg im glucaon; GlucoGel/Dextrogel

In - 75-80ml 20% glucose of 10% glucose or 20-50mls 50% dextrose iv

38
Q

What is the follow up for a hypo?

A

Long-acting CHO

39
Q

What are symptoms of DKA?

A 
Polyuria
Polydipsia
Weight loss
Weakness
Nausea/vomiting
Abdo pain 
Breathlessness
40
Q

What are signs of DKA?

A 
Dry mucous membranes
Sunken eyes
Tachycardia
Hypotension
Ketotic breath
Altered mental state
Hypothermia
41
Q

What are the initial investigations for DKA?

A 
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
42
Q

What could cause DKA?

A

Infection; severe stress; insulin omission

43
Q

What are some complications of DKA?

A
  • Hyper/hypo- kalaemia
  • Hypoglycaemia
  • Cerebral oedema
  • Aspiration pneumonia
  • Arterial + venous thromboembolism
  • ARDS
44
Q

What is the treatment for DKA in hospital HDU?

A 
IV saline 
IV insulin 
IV potassium in saline
May need abx
Consider heparin, NG tube

*Diabetes & Endocrinology (24 decks)

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