Management of Type 1 Diabetes Flashcards
Why is delayed diagnosis a problem?
DK is preventable and early diagnosis improves quality of life and reduces risk of developing complications
What is the 3 Ts of early diagnosis?
THINK - keep symptoms in mind
TEST
TELEPHONE - local specialist team for a a same say review
4 Ts of symptoms of type 1?
Thirsty
Thinner
Tired
Toilet
What is a red flag symptom of type 1?
Return to bed wetting or day wetting in a previously dry child
Early symptoms for children under 5?
- Heavier than usual nappies
- Blurred vision
- Candidiasis - oral/vulval
- Constipation
- Recurring skin infections
- Irritibility and behaviour changes
Symptoms of DKA?
- Nausea and vomiting
- Abdo pain
- Dehydration
- Sweet smelling ketotic breath
- Drowsiness
- Rapid, deep sighing respiration
What is normal blood pH?
7.35-7.45
How do we TEST immediately is type 1 is suspected? What should we not do?
Finger prick capillary blood glucose test
- >11mmol/l = diabetes
- <11mmol/l = other cause
Do NOT do a returned urine specimen, a fasting blood glucose test, an oral glucose tolerance test as these take TIME - something the patient may not have
Why do we arrange (telephone) a same day review with a specialist team?
Children can get DKA very quickly so important not to delay
Current strategies to support people with type 1?
- Education
- Nutrition and lifestyle management - exercise, calorie counting and CHOs
- Skills training - home BG testing and injection technique
- Insulin - analogues, pens, pumps
What to do before you inject insulin?
Check its the right insulin, right dose, right time and right way
Why is insulin injected?
It is a polypeptide hormone which is inactivated by the GI tract so can’t be consumed orally
Why is insulin given 30 mins before eating and not right before?
In the subcutaneous fat the Insulin molecule in solution can self-associate into hexamers Hexamers need to dissociate into monomers before absorption through the capillary bed - takes time
What types of insulin can be taken right before eating and why?
Fast acting analogues because they do not associate with hexamers
What can change the rate of insulin absorption?
Changing the structure of insulin or binding it to other molecules
How much insulin should be injected for a meal?
The amount of insulin injected for meals should balance the carbohydrate intake consumed
Name the current insulin regimes?
Twice daily
- Rapid + intermediate (mixed) before breakfast
- Rapid + intermediate before tea
Three times daily
- Rapid + intermediate before breakfast
- Rapid + intermediate before tea
- Intermediate before bed
Four times daily
- Short acting before, breakfast
- Short acting before lunch
- Short acting before dinner
- Intermediate before breakfast OR long acting at a fixed time
Why is a multiple injection regime that combines short and long acting insulin useful? What type of patients will use it?
Insulin and food go together so meal times and sizes can vary without affecting metabolic control - so more flexible Younger patients use it
What is the honeymoon period for type 1s?`
Some recovery of endogenous insulin secretion may occur over the 1st few months of treatment in type 1s where the insulin dose may need to be reduced But after insulin requirements do rise after this period
Target BG values before and after meals for type 1s?
4-7 mmoles/L before meals and 4-10 after a meal
Why is strict glucose control helpful from the onset in type 1s?
Prolongs b-cell function = better glucose levels and less hypos
What is a CSII?
Continuous s/c insulin infusion
Explain how a CSII works.
A small pump strapped around the waist that infuses a constant trickle of insulin via a needle in the s/c tissue
Mealtime doses delivered when user instructs pump to deliver a bolus of insulin at start of meal
Positives of the CSII device
Useful in overnight period as the rate can be programmed to fit each patients need
