Management of Type 1 Diabetes Mellitus Flashcards by Catherine Wright

What are the aims of diabetic management?

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

How well did you know this?

Not at all

Perfectly

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

Toilet (polyuria)

Thirsty (polydipsia)

Tired (fatigue)

Thinner (weight loss)

How well did you know this?

Not at all

Perfectly

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

Education

Nutrition and lifestyle management

Skills training

Insulin

How well did you know this?

Not at all

Perfectly

What are some examples of structured education for diabetes?

STEP

HEIDI

DAFNE

How well did you know this?

Not at all

Perfectly

What are some skills training for people with diabetes?

Home blood glucose monitoring

Injection technique

Managing hypos

Sick day rules

How well did you know this?

Not at all

Perfectly

What should be checked before administered insulin needle?

Right insulin (check name)

Right dose

Right time

Right way

How well did you know this?

Not at all

Perfectly

What is insulin?

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

How well did you know this?

Not at all

Perfectly

Why does insulin need to be injected subcutaneously?

It is inactivated by the GI tract

How well did you know this?

Not at all

Perfectly

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

Self-associate into hexamers

Which needs to dissociate into monomers before absorption through capillary bed

How well did you know this?

Not at all

Perfectly

Why should insulin be injected 30 minutes before a meal?

Needs to dissociate into monomers

How well did you know this?

Not at all

Perfectly

How long before a meal should insulin be injected?

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

How well did you know this?

Not at all

Perfectly

What are some examples of fast-acting insulin analogues?

Insulin lispro

Insulin aspart

How well did you know this?

Not at all

Perfectly

What are some examples of long acting insulin analogues?

Insulin glargine

Determir insulin

How well did you know this?

Not at all

Perfectly

What are some ways of educating people about their diabetes?

How well did you know this?

Not at all

Perfectly

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

Eating and activities

How well did you know this?

Not at all

Perfectly

What do sick day rules refer to?

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

How well did you know this?

Not at all

Perfectly

What is the guidance for blood ketones levels?

How well did you know this?

Not at all

Perfectly

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

Rapid acting

Short acting

Intermediate acting

Long acting

Continuous subcutaneous insulin infusion

How well did you know this?

Not at all

Perfectly

What are examples of rapid acting insulin?

Insulin lispro

Insulin aspart

How well did you know this?

Not at all

Perfectly

What are examples of short acting insulin?

Soluble insulin

Actrapid

Humulin S

How well did you know this?

Not at all

Perfectly

What are examples of intermediate acting insulin?

Isophane insulin

Insulatard

Humulinl

How well did you know this?

Not at all

Perfectly

What are examples of long acting insulin?

Glargine

Determir

Degludec

How well did you know this?

Not at all

Perfectly

What does CSII stand for?

Continuous subcutaneous insulin infusion

How well did you know this?

Not at all

Perfectly

What are some things that can change injection technique?

Needle size

Location

Rotation

Technique

What are some current insulin regiments?

Twice daily Three times daily Four times daily

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

1 unit per 10g of carbs

What insulin is used for twice daily regimen?

Rapid acting mixed with intermediate acting Before breakfast and evening meal

What insulin is used for three times daily regimen?

Rapid acting mixed with intermediate acting before breakfast Rapid acting before before dinner Intermediate acting at bedtime

What insulin is used for 4 times daily regimen?

Short acting before breakfast, before lunch and before dinner Intermediate acting before bed or long acting insulin at a fixed time once daily

What do adjustments to insulin need to be made for?

Lifestyle Exercise Driving Alcohol Conception Drugs Holidays Employment

What are examples of diabetic emergencies?

Hypoglycamia Hyperglycaemia (and diabetic ketoacidosis)

What is hypoglycaemia?

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

What are possible reasons for hypoglycaemia?

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

What are some examples of causes of hypoglycaemia?

What are some at risk groups of hypoglycaemia?

What are some symptoms of hypoglycaemia?

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

Recurrent severe hypoglycaemia Long duration of disease Over tight control Loss of sweating Tremor

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

Carbohydrates

What can happen if hypoglycaemia is prolonged?

Permanent neurological damage, coma or death

When are patients considered to have mild hypoglycaemia?

Conscious, orientated and able to swallow and not fasting

What is the treatment for mild hypoglycaemia?

Give 15-20g of fast acting carbohydrate

When are patients considered to have moderate hypoglycaemia?

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

What is the treatment for moderate hypoglycaemia?

1.5-2 tubes of glucose gel

When are patients considered to have severe hypoglycaemia?

Patient unconscious/fitting, very aggressive

What is the treatment for severe hypoglycaemia?

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

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

Determine what caused the hypoglycaemia

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

Wrong regimen (dose/insulin) Control and monitoring Hypoglycaemia unawareness Driving/work Food/activity Injection sites

What can be done to avoid hypoglycaemia?

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

What is the advice for driving and diabetes?

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

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

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

What does DKA stand for?

Diabetic ketoacidosis

What investigations are done for DKA?

What are some possible complications of DKA?

Hyper and hypokalaemia Hypoglycaemia (arrhythmias, acute brain injury) Cerebral oedema Aspiration pneumonia Arterial and venous thromboembolism ARDS

What is the treatment of DKA?

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

What are some sick day rules?

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

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

Optimal blood glucose control (HbA1c) Optimal blood pressure control Manage cardiovascular risk factors Screen for early detection of complications

What are some things regarding future development and diabetes?

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