Management of Type 1 Diabetes Flashcards
What are the aims of managment?
- Prompt diagnosis
- Encouragement of self management skill set
- Correction of acute metabolic upsets at diagnosis and thereafter
- Facilitate long term health and well being
What is the acronym for symptoms of diabetes?
THINK
What are the the three actions needed to make an early diagnosis of diabetes?
- THINK symptoms
- TEST immediately - finger prick capillary Glc test > 11mmol/l
- TELEPHONE urgently
What are the different THINK symptoms?
- Thirsty
- Thinner
- Tired
- Using the Toilet more
Other than the THINK symptoms, what else should you look for in under 5s?
- Heavier than usual nappies
- Blurred vision
- Candidiasis (oral, vulval)
- Constipation
- Recurring skin infections
- Irritability, behaviour change
What is a red flag symptoms of diabetes?
A return to bedwetting or day-wetting in a previously dry child
What are the six symptoms of diabetic ketoacidosis (DKA)?
- Nausea&vomiting
- Abdominalpain
- Sweetsmelling,”ketotic”
- Breath
- Drowsiness
- Rapid, deep “sighing” respiration
- Coma
What is the TEST used to carry out early diagnosis?
Finger prick capillary blood glucose test
Result > 11mmol/l - Diabetes
Result < 11mmol/l - Other cause
What tests shoud NOT be carried out of early diagnosis in acute situation?
- Request a returned urine specimen.
- Aarrange a fasting blood glucose test.
- Arrange an Oral Glucose Tolerance Test.
- Wait for lab results (urine or blood).
Who should you TELEPHONE for an early diagnosis?
Call local specialist paediatric diabetes team for a same day review
Name four current strategies used to support those with IDDM?
- Education
- Nutrition and lifestyle management
- Skills management - home BG monitoring, injection technique, hypos, sick day rules
- Insulin - analogues, pens, pumps
What four factors should be checked before a person injects insulin?
- Right insulin
- 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?
What does insulin need to be injected subcutaneously or intravenously?
As insulin is a polypeptide which is inactivated by the gastrointestinal tract
Why is soluble insulin given 30mins before eating?
In the subcutaneous fat Insulin molecule in solution has a tendency to self-associate into hexamers
Hexamers need to dissociate into monomers before absorption through the capillary bed.
How far in advance before a meal do rapid acting analogues of insulin need to be injected?
They do not associate and can be injected just before eating
How much insulin is injected prior to a meal?
The amount of insulin injected for meals should balance the carbohydrate intake consumed
What are different forms in which education is provided?
- Patient handbooks
- Leaflets
- Set curriculum (DIANE)
- Insulin pump starts
- Education days
- My Diabetes My Way (NHS online)
What is DIANE education?
Diabetes Insulin Adjustment for Normal Eating course • Deal life life issues • Food, exercise, travel etc • Insulin, blood testing • Sick day rules
What are the different types of insulin?
- Rapid acting
- Short acting
- Intermediate acting
- Long acting
- Continuous subcutaneous insulin infusion (CSII)
What are the four factors of insulin injection technique?
- Needle size
- Location
- Rotation
- Technique
Name the different injection sites
• Thighs
• Buttocks
• Belly
(• Arms but not commonly used as easy to inject into muscle)
What are the components on insulin therapy regimens?
- Suitable for a flexible lifestyle
- Better for shift workers
- Rapid acting insulin to cover CHO at meals 1 units per 10g CHO
- Basal long acting insulin as backgroup
What is the current insulin regimen with twice daily administration?
- Rapid acting mixed with intermediate acting
* Before breakfast (BB) and evening meal (BT)
What is the current insulin regimen with three times daily administration?
- Rapid acting mixed with intermediate acting BB
- Rapid acting BTea
- Intermediate acting at bedtime BBed
