Management of type 1 diabetes

Question 1

how many units of insulin is given for a meal containing 20g of CHO?

Answer 1

1 unit for every 10g therefore if 20g CHO = 2 units

Question 2

why is insulin given subcutaneously and not orally?

Answer 2

insulin is a polypeptide that is digested by the GI tract

Question 3

how can patients be educated on their diabetes?

Answer 3

leaflets / websites
patient handbooks
education days
my diabetes my way 
health care professional education
apps CHO/fitness

Question 4

what are the 2 main types of rapid acting insulin?

Answer 4

insulin lisper & insulin aspat ( Humalog)

Question 5

what are 2 main types of short acting insulin?

Answer 5

Humalin S and actrapid

Question 6

name an intermediate acting insulin.

Answer 6

humalin I

Question 7

what are the 2 types of Humalin insulins and how do they differ?

Answer 7

Humalin S = short acting

Humalin I = intermediate acting

Question 8

name a long acting insulin drug.

Answer 8

glargine
detemir
degludec

Question 9

how are insulin medications administered?

Answer 9

subcutaneous injections
or
continuous subcutaneous insulin infusion (CSII) - sensory augmented pumps

Question 10

what can occur as a complication of not rotating the insulin injection site?

Answer 10

lipohypertrophy

Question 11

what can be the reasons for a patient having an hypo?

Answer 11

too little food / wrong type
exercise
insulin - too high dose, injection technique (if it goes into muscle- the insulin can have greater effect)
alcohol 
inappropriate timing of insulin

Question 12

what are the symptoms of a hypo?

Answer 12

autonomic;
- sweating
- palpitations
- shaking 
- hunger 
neuroglycopenic;
- confusion 
- drowsiness 
- odd behaviour 
- speech difficulty
- incoordination
general malaise;
- headache
- nausea 
- blurred vision

Question 13

who are at risk of having a hypo?

Answer 13

rightly controlled diabetics 
coeliac disease
pancreatectomy 
renal/hepatic impairment
extremes of age
malabsorption 
hypoadrenalism / abrupt steroid withdrawal
impaired awareness/cognition

Question 14

what can happen to a patient with diabetes who experiences a lot of hypos?

Answer 14

they can lose the warning signs of hypoglycaemia due to recurrent hypos and long duration of disease

Question 15

what are the complications of a hypo?

Answer 15

coma
hemiparesis
seizures
neurological deficits if prolonged

Question 16

what allows Humalog to act rapid which allows a patient to administer the dose right before eating?

Answer 16

rapid acting insulins dont have dissociate before they can be absorbed into the capillaries - compared to other insulins;
non- rapid acting insulins form hexamers in the subcutaneous fat which has to be dissociated into monomers before it can be absorbed - therefore has to be taken at least 30 mins beofre eating

Question 17

what lifestyle factors can put someone at risk of a hypo?

Answer 17

irregular lifestyle
increasing exercise
increasing age
early pregnancy 
alcohol 
injection into lipodystrophy sites
iregular monitoring of BG