Management of Type 1 Diabetes Mellitus Flashcards
What are some symptoms of Diabetic Ketoacidosis?
- Abdominal pain
- Sweet smelling (ketotic) breath
- Rapid, deep respiration (Kussmauls)
- Tachycardia & hypotension
- Drowsiness
- Nausea and vomiting
- Coma
If signs of diabetic ketoacidosis are detected what should be done?
- Finger prick capillary blood glucose test
Result: - If >11 mM diabetes is the cause
- If < 11mM consider other causes
How is insulin usually administered?
- Subcutaneous injection
- IV during illness / surgery
How long before eating is insulin usually administered? Why does it need time to absorb before eating?
- 30 mins
- Because in the subcutaneous fat insulin tends to self associate into hexamers, these need to dissociate into monomers prior to absorption into the capillary bed
- Rapid acting insulin analogues do not associate and can be injected just before eating
Why does insulin need to be taken via injection and not orally?
- Because it is a polypeptide that is inactivated (denatured) by the GI tract
How can the rate of absorption of insulin be modified?
- Changing molecular structure / binding the insulin to other molecules can change the rate of absorption
What are some fast acting insulin analogues?
- insulin lispro
- Insulin aspart
What are some long acting insulin analogues?
- Insulin glargine
- Detemir insulin
What is the most important factor in ensuring Type 1 Diabetes is properly managed?
- Patient education
- Need to understand how / when to use insulin etc.
How can diabetes patients monitor their [BG] / ketone levels?
- Home blood glucose monitoring and ketone testing via skin prick tests
What blood ketone level in mM suggests DKA?
> 3.0mM
What can tend to lead to DKA in diabetic patients?
- Infections
- MI
- Omitting insulin
What is the peak age of onset for type 1 diabetes?
- Approximately 12 years old
What are the different types of insulin therapy available?
- Rapid acting insulins (lispro / aspart)
- Short acting insulins (soluble insulin / actrapid)
- Intermediate acting insulins (isophane / insulatard)
- Long acting insulins (glargine / detemir)
- Continuous subcutaneous insulin infusion (CSII)
What is continuous subcutaneous insulin infusion?
- Insulin pump therapy
- Involves wearing an insulin pump that provides a steady stream of insulin into your body
What is basal bolus insulin therapy?
- Patient takes a long acting insulin to maintain background insulin levels, and then takes rapid acting insulin to cover carbohydrates at meals
Who is basal bolus insulin therapy useful for? How much insulin is taken per dose of food?
- Better for flexible lifestyles / shift workers. Basically just taking insulin as needed
- 1 unit of insulin per 10g carbohydrates
What are the different types of insulin regimens?
- Twice daily
- Three times daily
- Four times daily
Describe the times and types of insulin taken on a twice per day regimen
- (Rapid acting and intermediate acting mix) taken before breakfast and before evening meal
Describe the times and types of insulin taken on a three times per day regimen
- Rapid acting and intermediate acting mix before breakfast
- Rapid acting before evening meal
- Intermediate acting before bed
Describe the times and types of insulin taken on a four times per day regimen
- Short acting before breakfast, lunch and evening meal
- Intermediate acting before bed OR long acting at a fixed time daily
What is hypoglycaemia? What may precipitate hypoglycaemia in diabetics?
Any episode of low blood glucose ( < 4 mM) with or without symptoms
- Food (too little / wrong type)
- Demanding activity
- Insulin (wrong dose / improper administration)
- Alcohol
Prognosis for isolated hypoglycaemia episodes in type 1 diabetics?
Most isolated hypoglycaemia events recover spontaneously even if left untreated
What are some symptoms of hypoglycaemia?
- Shakiness / dizziness / nausea
- Sweating
- Hunger
- palpitations
- Confusion / odd behaviour
- Headache
