Management of Type 1 Diabetes

Question 1

List some of the rapid acting analogue forms of insulin.

Answer 1

Humalog
Novorapid
Apidra

Question 2

Where do most people inject their insulin?

Answer 2

Tummy
Thighs
Sometimes bottom

Question 3

If it better to take insulin before or after eating?

Answer 3

Before

-> remember when E used to go down to the office before lunchtime

Question 4

What is the name given to the device which allows for continuous glucose monitoring using a phone?

Answer 4

Dexcom

Question 5

What are the symptoms of DKA?

Answer 5

Nausea and vomiting
Abdominal pain
Sweet smelling, ketonic breath
Drowsiness
Rapid, deep sighing respiration
Coma

Question 6

Which type of diabetes predominantly leads to DKA?

Answer 6

Type 1 but not always the case

Question 7

What is the initial management for DKA which must be carried out asap?

Answer 7

Normal saline and IV fluids
Start actrapid

Question 8

What are some of the potential complications of hypoglycaemia?

Answer 8

Rebound ketosis
Arrhythmias
Acute brain injury

Question 9

What can happen as a result of trying to increase fluids of a child with type 1 diabetes?

Answer 9

Cerebral oedema

Question 10

What BG level means a hypo?

Answer 10

<4mmol/L

-> less than four, on the floor

Question 11

What are some of the symptoms of a hypo?

Answer 11

Tachycardia
Shaking
Sweating
Dizziness
Hunger

Question 12

Hypos can be mild or severe. What is the difference?

Answer 12

Mild- patients know how to treat themselves
Severe- require assistance, in hospital

Question 13

What are some of the causes of a hypo?

Answer 13

Too much insulin
Inappropriate timing of insulin
Injection site problems
Inadequate food carbs
Exercise
Alcohol

Question 14

Which groups are more at risk of a hypo?

Answer 14

-Tight glycaemic control
-Impaired awareness
-Cognitive impairment
-Malabsorption
-Pancreatectomy
-Renal/hepatic impairment

Question 15

Management of a hypo?

Answer 15

Fast acting glucose

-> Dextrosol tablets, Glucotabs, Glucojuice- pure fruit juice

Question 16

What is CSII?

Answer 16

Continuous subcutaneous insulin infusion

-> given by a pump

Question 17

List some examples of short-acting insulin.

Answer 17

Actrapid
Humulim
Insuman Rapid

Question 18

Which type of insulin is taken before meals?

Answer 18

Rapid-acting insulin if immediately before eating
Short acting insulin if 30mind before

Question 19

How long does rapid acting insulin take to act and how long does it last?

Answer 19

5-10 mins
Lasts 2-5hrs

Question 20

How long does short acting insulin take to work and how long does it last?

Answer 20

30mins-1hr
Lasts up to 8hrs

Question 21

How long does intermediate acting insulin take to work and how long does it last?

Answer 21

2hrs
Lasts 8-14hrs

Question 22

How long does long acting insulin take to work and how long does it last?

Answer 22

2hrs
Lasts 18-24hrs

Question 23

Give some examples of intermediate-acting insulin.

Answer 23

Isophane insulin- insuman, Insulatard, Humulin

Question 24

Give some examples of long-acting insulin.

Answer 24

Insulin detemir- Levemir
Insulin glargine- Lantus, Abasaglar

Question 25

If using an insulin pump, which insulin is used alongside the pump?

Answer 25

Long-acting insulin

Question 26

Benefits of insulin pump?

Answer 26

-Reduction of hypos
-Return of hypo awareness
-Improved control and flexibility
-No daily injections
-More accurate insulin delivery

Question 26

Which type of insulin does the insulin pump use to control glucose levels?

Answer 26

Rapid-acting insulin

Question 26

When may an insulin pump be considered for a patient?

Answer 26

If they have hypoglycaemia unawareness
If they would benefit from the flexibility a pump provides
If they experience Dawn Phenomenon- reasonable glucose levels overnight w dramatic rise upon waking
If trying for pregnancy
Inadequate control of diabetes

Question 27

What are some of the challenges of an insulin pump?

Answer 27

-Risk of site infection
-Pump may malfunction
-Infusion set change required every 2-3 days
-Must have good knowledge of carbohydrate counting
-Pump must be worn all day, everyday