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D&E Pathology > Management of Type 1 DM > Flashcards

Management of Type 1 DM Flashcards

1
Q

What are the aims of T1DM management?

A
  • Prompt diagnosis
  • Encourage appropriate self-management
  • Correction of acute metabolic upsets
  • Facilitate long-term health
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2
Q

What immune factors take place in T1D?

A 
Islet autoantibodies
HLA class 2 association
Beta-cell T cells found in human islets
Immune modulation delays progress
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3
Q

How many children are diagnosed with diabetes every year?

A

300

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4
Q

How are a large portion of children diagnosed with diabetes?

A

1 in 4 present with DKA

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5
Q

Symptoms of childhood T1D?

A

Thirsty
Thinner
Tired
Toileting more

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6
Q

What must be done for suspected diabetes?

A

THINK - symptoms
TEST - capillary glucose
TELEPHONE - specialist for same day review

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7
Q

What capillary glucose is suggestive of T1D?

A

> 11mmol/L

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8
Q

What is the red flag symptom of childhood diabetes?

A

Return to bedwetting

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9
Q

What key symptoms are more common in children under 5?

A 
Heavier nappies
Blurred vision 
Candidiasis 
Constipation
Recurring skin infections
Irritability, behaviour changes
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10
Q

Symptoms of DKA?

A 
Nausea and Vomiting
Abdominal Pain
Polyuria
Polydipsia
Ketotic breath
Drowsiness/Confusion
Rapid "sighing" breath - Kussmaul
Coma
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11
Q

What should you do for a patient suspected to be in DKA?

A

Finger prick test

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12
Q

Who should you call in a DKA positive child?

A

Paediatric diabetes team same day

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13
Q

What blood tests should be performed in a suspected DKA patient after prick test?

A

Blood Glucose

Blood ketones

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14
Q

What strategies are in place to support T1D patients?

A

Education
Nutrition and lifestyle management
Skills training
Insulin

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15
Q

What should be checked before giving insulin?

A

Right insulin
Right dose
Right time
Right way - medium

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16
Q

Why must insulin be injected?

A

Its inactivated by the GIT

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17
Q

Why is insulin injected before eating?

A

Insulin in fat forms hexamers which take approximately 30 mins before breaking up

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18
Q

What are rapid acting analogues?

A

This Insulin does not associate and can be injected right before eating

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19
Q

What are the fast acting analogues?

A

Insulin lispro

Insulin aspart

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20
Q

What are the slow acting analogues?

A

Insulin glargine

Detemir insulin

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21
Q

What is the rough ratio of units of fast acting insulin to grams of sugar?

A

1 unit of insulin for 10g of carbs

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22
Q

What factors can be considered part of educating diabetic patients?

A

Handbooks, leaflets, Insulin pump starts, pregnancy, education days, help groups
Mydiabetes myway

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23
Q

What things need to be in a structured education of a T1D patient?

A 
Dealing with real life issues
Food
Exercise
Travel
Insulin
Blood testing/hypo
Sick days
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24
Q

When is a patient in DKA?

A

Blood ketones >3mmol/L

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25
Q

At what blood ketone level should a diabetes team be contacted?

A

> 1.5mmol/L

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26
Q

What is a normal ketone level?

A

<0.6mmol/L

27
Q

What do you do if you have a ketone level between 0.6-1.4 and blood sugar >14?

A

Drink sugar fluids
Correction dose insulin
Retest in 1-2hrs

28
Q

What do you do if you have a ketone level below 0.6 and blood sugar >14?

A

Retest in 1-2hrs

29
Q

What do you do if you have a ketone level between 1.5-2.9 and blood sugar >14?

A

Drink sugar fluids
Correction dose of insulin
Retest hourly
CONTACT DIABETES TEAM

30
Q

What do you do if you have a ketone level over 3 and blood sugar >14?

A

Sugar fluids
Correction dose insulin
Retest hourly
Attend hospital probs lol

31
Q

What types of insulin action are there?

A 
Rapid acting 
Short acting
Intermediate acting
Long acting
Continuous subcutaneous infusion
32
Q

What are the current insulin regimens?

A

Twice daily
Three daily
Four times daily

33
Q

What is the regimen for twice daily insulin?

A

Rapid mixed with intermediate acting

Before breakfast and evening meal

34
Q

What is the regimen for three times daily insulin?

A

Rapid mixed with intermediate before bed
Rapid acting before evening meal
Intermediate at bedtime

35
Q

What is the regimen for four times daily insulin?

A

Short acting before breakfast, lunch and dinner
Intermediate before bed
OR
Long acting at fixed time once each day

36
Q

What factors can be adjusted to help with care of a T1D patient?

A 
Lifestyle
Exercise
Driving
Alcohol
Contraception 
Drugs
Holidays 
Employment
37
Q

What is hypoglycaemia?

A

ANY episode of low blood sugar <4mmol/L with or without symptoms

38
Q

What factors cause hypoglycaemia in a T1D patient?

A 
Activity
Food
Insulin - timing, volume, injecton site
Alcohol
Oral hypoglycaemics
39
Q

Which groups are at high risk of hypoglycaemia?

A 
Tight glycaemic control
Lowered awareness/cognitive function
Extremities of age
Malabsorption
Hypoadrenalism
Renal impairment
Pancreatectomy
Pregnancy
Coeliacs
40
Q

What should patients be taught about hypoglycaemia?

A

How to avoid, recognise and treat it

41
Q

What are the symptoms of hypoglycaemia?

A

Vary between individuals
Autonomic
Neuroglycopenic
Malaise

42
Q

What are the autonomic symptoms of hypoglycaemia?

A

Sweating
Palpitations
Shaking
Hunger

43
Q

What are the neuroglycopenic symptoms of hypoglycaemia?

A 
Confusion
Drowsiness
Odd behaviour
Speech difficulty
Incoordination
44
Q

INABILITY TO PERCIEVE NORMAL WARNING SYMPTOMS OF HYPOGLYCAEMIA is associated with what?

A

Recurrent severe hypo
Long duration of disease
Loss of sweating/tremor
Over tight control

45
Q

Which patients should be told to carry CHO with them?

A

Patients on insulin or sulphonylureas

46
Q

How should hypoglycaemia be treated in a patient able to take oral CHO?

A 
If able to take oral CHO:
15-20g simple CHO
5-7 dextrosol/4-5 glucotabs
200ml fruit juice
Follow up with long acting CHO
47
Q

How should hypoglycaemia be treated in a patient unable to take oral CHO?

A 
Out of hospital:
- 1mg IM glucagon
- Glucogel/dextrogel
Hospital:
-  75-80ml 20% glucose IV
-  25mls 50% dextrose IV
Follow up with long acting CHO
48
Q

All patients in hypo should have their treatment followed up with what?

A

Long acting CHO

49
Q

Whats in the Hypobox?

A 
Fruit juice
Dextro energy
Glucogel
20% or 50% dextrose
Hypo management protocol
50
Q

What should you do with the patient after recovery?

A 
Establish cause of hypo
Control/monitoring?
Hypoglycaemia awareness
Repeated injection site?
Driving/work
51
Q

How can hypos be avoided in insulin-treated diabetes?

A 
Blood glucose monitoring
Rotate injection sites
Review snacks and diet
Consider changing regimen
Avoid low glucose
Insulin before + after exercise
52
Q

How should diabetic patients approach driving?

A

Always carry carbohydrates
No driving if not aware
Measure glucose before
No more than 1 hypo in a year

53
Q

What are the symptoms of DKA?

A 
Polyuria
Polydipsia
Weight loss
Weakness
N+V
Abdo pain
Breathlessness
54
Q

What are the signs of DKA?

A 
Ketone breath
Coma
Hypotension
Tachycardia 
Altered mental state
Sunken eyes
Dry mucus membranes
Kussmaul breathing
55
Q

What patients are at risk of DKA?

A

T1DM
Inadequate insulin
Infection

56
Q

What are the rules of managing diabetes with acute illness?

A 
Never stop insulin
Increase/adjust insulin
More frequent checks
Check urine/blood for ketones
Carbohydrate intake must be maintained
57
Q

How does increased glucagon aid to trigger DKA?

A

Increased lipolysis

58
Q

How does increased cortisol aid to trigger DKA?

A

Decreased glucose utilisation

59
Q

How does increased GH aid to trigger DKA?/??\/????

A

Increased proteolysis

Decreased protein

60
Q

How does increased catecholamines aid to trigger DKA?

A

Increased Glycogenolysis leading to increased gluconeogenesis

61
Q

What investigations should be done on a suspected DKA?

A 
Rapid ABC
Iv access
Vitals
Glucose
ABG
U+E, FBC
Blood culture
ECG
Consider CXR
62
Q

Complications of DKA

A 
Hyper/hypokalaemia
Hypoglycaemia
Cerebral oedema
Aspiration pneumonia
Thromboembolism
ARDS
63
Q

Cerebral oedema is more common in who? How does it present?

A

Children

Hyperosmolar hyperglycaemic state

64
Q

How is DKA treated in the HDU?

A 
IV saline
Iv insulin
Iv Potassium
?heparin, NG tube
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D&E Pathology (18 decks)

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