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Endocrine System > Management of Type 1 Diabetes > Flashcards

Management of Type 1 Diabetes Flashcards

1
Q

What are the aims of managment?

A
  • Prompt diagnosis
  • Encouragement of self management skill set
  • Correction of acute metabolic upsets at diagnosis and thereafter
  • Facilitate long term health and well being
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2
Q

What is the acronym for symptoms of diabetes?

A

THINK

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3
Q

What are the the three actions needed to make an early diagnosis of diabetes?

A
  • THINK symptoms
  • TEST immediately - finger prick capillary Glc test > 11mmol/l
  • TELEPHONE urgently
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4
Q

What are the different THINK symptoms?

A
  • Thirsty
  • Thinner
  • Tired
  • Using the Toilet more
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5
Q

Other than the THINK symptoms, what else should you look for in under 5s?

A
  • Heavier than usual nappies
  • Blurred vision
  • Candidiasis (oral, vulval)
  • Constipation
  • Recurring skin infections
  • Irritability, behaviour change
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6
Q

What is a red flag symptoms of diabetes?

A

A return to bedwetting or day-wetting in a previously dry child

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7
Q

What are the six symptoms of diabetic ketoacidosis (DKA)?

A
  • Nausea&vomiting
  • Abdominalpain
  • Sweetsmelling,”ketotic”
  • Breath
  • Drowsiness
  • Rapid, deep “sighing” respiration
  • Coma
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8
Q

What is the TEST used to carry out early diagnosis?

A

Finger prick capillary blood glucose test
Result > 11mmol/l - Diabetes
Result < 11mmol/l - Other cause

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9
Q

What tests shoud NOT be carried out of early diagnosis in acute situation?

A
  • Request a returned urine specimen.
  • Aarrange a fasting blood glucose test.
  • Arrange an Oral Glucose Tolerance Test.
  • Wait for lab results (urine or blood).
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10
Q

Who should you TELEPHONE for an early diagnosis?

A

Call local specialist paediatric diabetes team for a same day review

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11
Q

Name four current strategies used to support those with IDDM?

A
  • Education
  • Nutrition and lifestyle management
  • Skills management - home BG monitoring, injection technique, hypos, sick day rules
  • Insulin - analogues, pens, pumps
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12
Q

What four factors should be checked before a person injects insulin?

A
  • 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?
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13
Q

What does insulin need to be injected subcutaneously or intravenously?

A

As insulin is a polypeptide which is inactivated by the gastrointestinal tract

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14
Q

Why is soluble insulin given 30mins before eating?

A

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.

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15
Q

How far in advance before a meal do rapid acting analogues of insulin need to be injected?

A

They do not associate and can be injected just before eating

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16
Q

How much insulin is injected prior to a meal?

A

The amount of insulin injected for meals should balance the carbohydrate intake consumed

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17
Q

What are different forms in which education is provided?

A
  • Patient handbooks
  • Leaflets
  • Set curriculum (DIANE)
  • Insulin pump starts
  • Education days
  • My Diabetes My Way (NHS online)
18
Q

What is DIANE education?

A 
Diabetes Insulin Adjustment for Normal Eating course 
• Deal life life issues 
• Food, exercise, travel etc 
• Insulin, blood testing 
• Sick day rules
19
Q

What are the different types of insulin?

A
  • Rapid acting
  • Short acting
  • Intermediate acting
  • Long acting
  • Continuous subcutaneous insulin infusion (CSII)
20
Q

What are the four factors of insulin injection technique?

A
  • Needle size
  • Location
  • Rotation
  • Technique
21
Q

Name the different injection sites

A

• Thighs
• Buttocks
• Belly
(• Arms but not commonly used as easy to inject into muscle)

22
Q

What are the components on insulin therapy regimens?

A
  • 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
23
Q

What is the current insulin regimen with twice daily administration?

A
  • Rapid acting mixed with intermediate acting

* Before breakfast (BB) and evening meal (BT)

24
Q

What is the current insulin regimen with three times daily administration?

A
  • Rapid acting mixed with intermediate acting BB
  • Rapid acting BTea
  • Intermediate acting at bedtime BBed
25
Q

What is the current insulin regimen with four times daily administration?

A
  • Short acting BBreakfast BLunch BTea

* Intermediate BBed or long acting insulin at a fixed time once daily

26
Q

What adjustments have to be made with a diagnosis of diabetes?

A
  • Lifestyle
  • Exercise
  • Driving
  • Alcohol
  • Conception
  • Drugs
  • Holidays
  • Employment
27
Q

What are two acute metabolic upsets?

A
  • Hypoglycaemia

* Hyperglycaemia - diabetic ketoacidosis

28
Q

Define hypoglycaemia

A

Refers to any episode of low blood glucose (<4mmol/l) with or without symptoms and may occur in patients taking insulin or sulphonylureas.

29
Q

Name different causes of hypoglycaemia

A
  • Too much insulin/SU
  • Inappropriate timing of insulin/SU
  • Injection site problems
  • Inadequate food intake/fasting
  • Exercise
  • Alcohol
30
Q

Name five at risk of hypoglycaemia groups

A
  • Cognitive impairments
  • Extremes of age
  • Malabsorption
  • Coeliac disease
  • Pregnancy
31
Q

What are the symptoms of hypoglycaemia?

A

Autonomic:
• Sweating
• Palpitations

Neuro:
• Confusion 
• Drowsiness
• Speech difficulty 
• Incoordination

General malaise:
• Headache
• Nausea

32
Q

Why does a loss of warnings of hypoglycaemia occur?

A
  • Recurrent severe hypoglycaemia
  • Long duration of disease
  • Over tight control
  • Loss of sweating / tremor
33
Q

What is the treatment of hypoglycaemia?

A

If able: 15-20g simple CHO
• Dextrosol/Glucotabs
• 200ml fruit juice

If unable to take oral CHO
Out of hospital:
• 1mg IM glucagon
• GlucoGel®/ Dextrogel®

In hospital:
• Glucose or dextrose IV

Follow-up with long-acting CHO

34
Q

What is usually found inside a hypobox?

A
  • Fruit juice
  • Dextro energy
  • Glucogel
  • Dextrose
  • Hypo management protocol
35
Q

How does hypoglycaemia affect the ability to drive?

A
  • Patients should check their blood glucose before 2 hours of driving and during long car journeys and should always carry carbohydrate in the car.
  • No awareness then no driving
  • No more than one episode of severe hypo (Group 1) in a year
36
Q

What are the sick day rules?

A
  • Never stop insulin
  • Perform more frequent BG checks
  • Check urine or blood for ketones
  • CHO intake to be maintained by fluid (fruit juice) if unable to tolerate food
37
Q

How does diabetic ketoacidosis occur?

A
  • Results from too little insulin leading to fat breakdown and by-product of this are ketones
  • Usually associated with high glucose
  • Fluid deplete
38
Q

What is the clinical presentation of diabetic ketoacidosis?

A
  • Dehydrated
  • Thirsty
  • Abdominal pain
  • Acidotic breathing (Kussmauls)
  • Acetone on breath
  • Tachycardic and low BP
39
Q

What are the initial investigations used for DKA?

A

Rapid ABC:
• IV access
• Vital signs

  • Glucose
  • Venous blood gas
  • Urinalysis/Blood ketones / bicarbonate
  • U+E, FBC
  • Culture blood/urine
  • ECG + cardiac monitor
  • Consider CXR
40
Q

What are the possible complications of DKA?

A 
• Hyper and hypokalaemia
• Hypoglycaemia
    - Rebound ketosis
    - Arrhythmias
    - Acute brain injury
• Cerebral oedema
• Aspiration pneumonia
• Arterial and venous thromboembolism
• ARDS
41
Q

How is DKA treated?

A
  • Give IV saline (5L in 24hrs)
  • Give IV insulin (drives glucose and potassium into cells)
  • Give IV potassium in saline
  • May need antibiotics
  • Consider heparin, NG tube
42
Q

How can a person faciliatate long term health and well being?

A
  • Optimal BG control (HbA1c)
  • Optimal BP control
  • Mange CVS risk factors - smoking, cholesterol
  • Screen for early detection of complications - feet, eyes + kidneys

Endocrine System (29 decks)

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