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7. Endocrinology (Medical Knowledge)a > Management of Type 1 Diabetes Mellitus > Flashcards

Management of Type 1 Diabetes Mellitus Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the aims of diabetic management?

A

Prompt diagnosis

Encouragement of appropriate self management skill set

Correction of acute metabolic upsets at diagnosis and after

Facilitate long term health and well being

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2
Q

What symptoms should be considered to allow for early diagnosis in diabetes?

A

Toilet (polyuria)

Thirsty (polydipsia)

Tired (fatigue)

Thinner (weight loss)

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3
Q

What are some categories of strategies to support people with type 1 diabetes?

A

Education

Nutrition and lifestyle management

Skills training

Insulin

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4
Q

What are some examples of structured education for diabetes?

A

STEP

HEIDI

DAFNE

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5
Q

What are some skills training for people with diabetes?

A

Home blood glucose monitoring

Injection technique

Managing hypos

Sick day rules

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6
Q

What should be checked before administered insulin needle?

A

Right insulin (check name)

Right dose

Right time

Right way

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7
Q

What is insulin?

A

Polypeptide which is inactivated by GI tract so needs to be injected subcutaneously or IV

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8
Q

Why does insulin need to be injected subcutaneously?

A

It is inactivated by the GI tract

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9
Q

What happens to insulin once it is injected into subcutaneous fat?

A

Self-associate into hexamers

Which needs to dissociate into monomers before absorption through capillary bed

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10
Q

Why should insulin be injected 30 minutes before a meal?

A

Needs to dissociate into monomers

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11
Q

How long before a meal should insulin be injected?

A

30 minutes before, unless it is a fast acting analogue which can be imjected just before eating

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12
Q

What are some examples of fast-acting insulin analogues?

A

Insulin lispro

Insulin aspart

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13
Q

What are some examples of long acting insulin analogues?

A

Insulin glargine

Determir insulin

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14
Q

What are some ways of educating people about their diabetes?

A
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15
Q

What does the amount of insulin need to be adjusted for?

A

Eating and activities

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16
Q

What do sick day rules refer to?

A

Guidance to keep blood sugar levels as close to normal as possible when suffering from being ill

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17
Q

What is the guidance for blood ketones levels?

A
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18
Q

Insulins have different durations of action, what are some categories?

A

Rapid acting

Short acting

Intermediate acting

Long acting

Continuous subcutaneous insulin infusion

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19
Q

What are examples of rapid acting insulin?

A

Insulin lispro

Insulin aspart

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20
Q

What are examples of short acting insulin?

A

Soluble insulin

Actrapid

Humulin S

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21
Q

What are examples of intermediate acting insulin?

A

Isophane insulin

Insulatard

Humulinl

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22
Q

What are examples of long acting insulin?

A

Glargine

Determir

Degludec

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23
Q

What does CSII stand for?

A

Continuous subcutaneous insulin infusion

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24
Q

What are some things that can change injection technique?

A

Needle size

Location

Rotation

Technique

25
Q

What are some current insulin regiments?

A

Twice daily

Three times daily

Four times daily

26
Q

For rapid (short) acting inuslin, 1 unit covers how much carbs?

A

1 unit per 10g of carbs

27
Q

What insulin is used for twice daily regimen?

A

Rapid acting mixed with intermediate acting

Before breakfast and evening meal

28
Q

What insulin is used for three times daily regimen?

A

Rapid acting mixed with intermediate acting before breakfast

Rapid acting before before dinner

Intermediate acting at bedtime

29
Q

What insulin is used for 4 times daily regimen?

A

Short acting before breakfast, before lunch and before dinner

Intermediate acting before bed or long acting insulin at a fixed time once daily

30
Q

What do adjustments to insulin need to be made for?

A

Lifestyle

Exercise

Driving

Alcohol

Conception

Drugs

Holidays

Employment

31
Q

What are examples of diabetic emergencies?

A

Hypoglycamia

Hyperglycaemia (and diabetic ketoacidosis)

32
Q

What is 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

33
Q

What are possible reasons for hypoglycaemia?

A

Imbalance between food (too little/wrong type), activity and insulin

34
Q

What are some examples of causes of hypoglycaemia?

A
35
Q

What are some at risk groups of hypoglycaemia?

A
36
Q

What are some symptoms of hypoglycaemia?

A
37
Q

What is the inability to perceive normal warning symptoms of hypoglycaemia associated with?

A

Recurrent severe hypoglycaemia

Long duration of disease

Over tight control

Loss of sweating

Tremor

38
Q

What should all patients treated with insulin or sulphonylureas for diabetes carry with them incase they suffer from a hypo?

A

Carbohydrates

39
Q

What can happen if hypoglycaemia is prolonged?

A

Permanent neurological damage, coma or death

40
Q

When are patients considered to have mild hypoglycaemia?

A

Conscious, orientated and able to swallow and not fasting

41
Q

What is the treatment for mild hypoglycaemia?

A

Give 15-20g of fast acting carbohydrate

42
Q

When are patients considered to have moderate hypoglycaemia?

A

Conscious and able to swallow, but confused, disorientated or aggressive

43
Q

What is the treatment for moderate hypoglycaemia?

A

1.5-2 tubes of glucose gel

44
Q

When are patients considered to have severe hypoglycaemia?

A

Patient unconscious/fitting, very aggressive

45
Q

What is the treatment for severe hypoglycaemia?

A

Check ABC

Stop IV insulin, give IV glucose over 10 to 15 minutes as:

  • 75ml 20% glucose or 150ml 10% glucose or 1mg glucagon IM once only
46
Q

What should be done after a patient has recovered from hypoglycaemia?

A

Determine what caused the hypoglycaemia

47
Q

What are some examples of things that can lead to hypoglycaemia?

A

Wrong regimen (dose/insulin)

Control and monitoring

Hypoglycaemia unawareness

Driving/work

Food/activity

Injection sites

48
Q

What can be done to avoid hypoglycaemia?

A

Blood glucose monitoring

Rotate and check injection sites

Review snacks and diet (carb counting)

Consider a change in insulin regimen

Avoid low glucose

Alter insulin before and after exercise

49
Q

What is the advice for driving and diabetes?

A

Check blood glucose before/within 2 hours of driving and during long car journeys should always carry carbohydrates

50
Q

What are some risk factors of diabetic ketoacidosis (DKA)?

A
51
Q

What is the clinical presentation of diabetic ketoacidosis (DKA)?

A
52
Q

What does DKA stand for?

A

Diabetic ketoacidosis

53
Q

What investigations are done for DKA?

A
54
Q

What are some possible complications of DKA?

A

Hyper and hypokalaemia

Hypoglycaemia (arrhythmias, acute brain injury)

Cerebral oedema

Aspiration pneumonia

Arterial and venous thromboembolism

ARDS

55
Q

What is the treatment of DKA?

A

Follow local DKA protocol:

  • measure glucose/U and Es/ketones/bicarbonate/arterial blood gas
  • give IV saline (5L over 24 hours)
  • give IV potassium in saline
  • may need antibiotics
  • consider heparin
56
Q

What are some sick day rules?

A

Never stop insulin

Increase/adjust insulin dose according to blood glucose

Perform more frequent blood glucose checks

Check urine or blood for ketones

Carbs intake must be maintained by fluids (such as fruit juice) if unable to tolerate food

57
Q

How is long term health and well being facilitated in diabetes?

A

Optimal blood glucose control (HbA1c)

Optimal blood pressure control

Manage cardiovascular risk factors

Screen for early detection of complications

58
Q

What are some things regarding future development and diabetes?

A

Technology that automatically administers insulin in response to blood glucose and meals

Further optimisation of subcutaneous insulin delivery

Donor transplantation (Islets or pancreas)

Other cell-based therapies

Prevention

7. Endocrinology (Medical Knowledge)a (28 decks)

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