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Endocrine > Management of Type 1 Diabetes Mellitus > Flashcards

Management of Type 1 Diabetes Mellitus Flashcards

1
Q

What are some symptoms of Diabetic Ketoacidosis?

A
  • Abdominal pain
  • Sweet smelling (ketotic) breath
  • Rapid, deep respiration (Kussmauls)
  • Tachycardia & hypotension
  • Drowsiness
  • Nausea and vomiting
  • Coma
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2
Q

If signs of diabetic ketoacidosis are detected what should be done?

A
  • Finger prick capillary blood glucose test
    Result:
  • If >11 mM diabetes is the cause
  • If < 11mM consider other causes
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3
Q

How is insulin usually administered?

A
  • Subcutaneous injection

- IV during illness / surgery

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4
Q

How long before eating is insulin usually administered? Why does it need time to absorb before eating?

A
  • 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
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5
Q

Why does insulin need to be taken via injection and not orally?

A
  • Because it is a polypeptide that is inactivated (denatured) by the GI tract
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6
Q

How can the rate of absorption of insulin be modified?

A
  • Changing molecular structure / binding the insulin to other molecules can change the rate of absorption
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7
Q

What are some fast acting insulin analogues?

A
  • insulin lispro

- Insulin aspart

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8
Q

What are some long acting insulin analogues?

A
  • Insulin glargine

- Detemir insulin

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9
Q

What is the most important factor in ensuring Type 1 Diabetes is properly managed?

A
  • Patient education

- Need to understand how / when to use insulin etc.

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10
Q

How can diabetes patients monitor their [BG] / ketone levels?

A
  • Home blood glucose monitoring and ketone testing via skin prick tests
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11
Q

What blood ketone level in mM suggests DKA?

A

> 3.0mM

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12
Q

What can tend to lead to DKA in diabetic patients?

A
  • Infections
  • MI
  • Omitting insulin
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13
Q

What is the peak age of onset for type 1 diabetes?

A
  • Approximately 12 years old
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14
Q

What are the different types of insulin therapy available?

A
  • 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)
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15
Q

What is continuous subcutaneous insulin infusion?

A
  • Insulin pump therapy

- Involves wearing an insulin pump that provides a steady stream of insulin into your body

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16
Q

What is basal bolus insulin therapy?

A
  • Patient takes a long acting insulin to maintain background insulin levels, and then takes rapid acting insulin to cover carbohydrates at meals
17
Q

Who is basal bolus insulin therapy useful for? How much insulin is taken per dose of food?

A
  • Better for flexible lifestyles / shift workers. Basically just taking insulin as needed
  • 1 unit of insulin per 10g carbohydrates
18
Q

What are the different types of insulin regimens?

A
  • Twice daily
  • Three times daily
  • Four times daily
19
Q

Describe the times and types of insulin taken on a twice per day regimen

A
  • (Rapid acting and intermediate acting mix) taken before breakfast and before evening meal
20
Q

Describe the times and types of insulin taken on a three times per day regimen

A
  • Rapid acting and intermediate acting mix before breakfast
  • Rapid acting before evening meal
  • Intermediate acting before bed
21
Q

Describe the times and types of insulin taken on a four times per day regimen

A
  • Short acting before breakfast, lunch and evening meal

- Intermediate acting before bed OR long acting at a fixed time daily

22
Q

What is hypoglycaemia? What may precipitate hypoglycaemia in diabetics?

A

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
23
Q

Prognosis for isolated hypoglycaemia episodes in type 1 diabetics?

A

Most isolated hypoglycaemia events recover spontaneously even if left untreated

24
Q

What are some symptoms of hypoglycaemia?

A
  • Shakiness / dizziness / nausea
  • Sweating
  • Hunger
  • palpitations
  • Confusion / odd behaviour
  • Headache
25
Q

Treatment of hypoglycaemia?

A
  • 15-20g of simple carbohydrates orally

If unable to take oral carbs:

  • Out of hospital: 1mg intramuscular glucagon
  • In hospital: IV glucose (75-80mL 20% glc.)

Follow up with long acting carb source

26
Q

What should patients prone to hypoglycaemia do before driving?
What should they ALWAYS carry on them?

A
  • Check [BG]

- Should always carry a carb source on them

27
Q

What are the “sick day rules” for insulin treated patients? (rules for when they are ill)

A
  • Never stop insulin
  • Adjust insulin to [BG]
  • Perform more frequent [BG] tests, check urine / blood for ketones
  • Maintain carb intake (fruit juice if can’t eat)
28
Q

Investigations for DKA patients?

A
  • Blood: glucose, venous blood gas, ketones, bicarbonate
  • Urine: ketones
  • Septic screen: CXR, urine / blood / stool cultures
29
Q

What are some possible complications of DKA?

A
  • Hyper / Hypokalaemia
  • Hypoglycaemia (rebound ketosis)
  • Cerebral oedema (70-80% of DKA death in <12yrs old)
  • Aspiration pneumonia, thromboembolism, ARDS
30
Q

Treatment of DKA in hospital?

A
  • Blood monitoring
  • IV saline + potassium (5 L in 24 hours)
  • IV insulin
  • Antibiotics?
31
Q

What should you aim to keep the HbA1c at or below in type 1 diabetics?

A

< 7% (from textbook)

  • Slides say NICE target is <59 mmol/mol, might be a children’s value though not sure
32
Q

What is a donor dependent treatment method that is promising to be used in the future? (terrible wording)

A
  • Transplantation of islet cells

Or transplantation of pancreas +/- kidney

33
Q

What are sensor augmented pumps?

A
  • Insulin pumps with full integration of insulin delivery with real time [BG] monitoring

Potential to act like an artificial pancreas

Endocrine (30 decks)

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