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Year 2 - Endocrine > Management of type 1 DM > Flashcards

Management of type 1 DM Flashcards

1
Q

Describe the management of a patient with a new diagnosis of Type I Diabetes (6)

A

Encourage a self management mindset
Correct any acute metabolic upsets at diagnosis
Education about diet (carbohydrate) and lifestyle
Insulin – administration, technique and dose
How to do home blood sugar and ketone testing
How to manage a hypo

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2
Q

Patient education resources on DM

A

STEP (Scottish type 1 educational programme)

DIANE

Online

  • diabetes UK
  • My Diabetes My Way

Group education session
-course to help understand + manage condition

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3
Q

Strategies to support type 1 diabetics (3)

A

Patient education on their condition

  • from MDT
  • structured techniques to control BG

Teaching them to manage lifestyle

  • carbohydrate counting
  • exercise

Skills training

  • home BG monitoring
  • injection technique
  • how to deal with hypos
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4
Q

What is DIANE

A

DiabetesInsulin Adjustment for Normal Eating
-a way of managing Type 1 diabetes and provides people with the skillsnecessary to estimate the carbohydrate in each meal and to inject the right dose of insulin

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5
Q

Outline the principles of insulin therapy (4)

A

Right insulin - check the name

Right dose

Right time - morning/with food

Right administration - syringe/pen/pump

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6
Q

Why can’t therapeutic insulin be taken orally

A

As it’s a peptide hormone, it would be denatured by the digestive processes before it could enter the blood

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7
Q

How is insulin administered (2)

A

Subsutaneously -usually

IV - if acutely ill

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8
Q

Modified v unmodified insulin

A

Modified
-those that are more readily absorbed from the injection site and therefore act faster than natural insulin injected subcutaneously, intended to supply the bolus level of insulin needed at mealtime (prandial insulin)

Unmodified
-those that are released slowly over a period of between 8 and 24 hours, intended to supply the basal level of insulin during the day and particularly at night (basal insulin)

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9
Q

Basal v bolus insulin

A

Basal insulin, also referred to as background insulin, regulates your glucose levels in between meals, i.e. long acting insulin

Bolus insulin is extra insulin needed to manage your glucose levels after a meal, i.e. rapid or short acting insulin

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10
Q

When unmodified insulin is injected, what does it have a tendency to do in the subcutaneous tissue and so what implication does this have on the time it has to be injected

A

the insulin molecules have a tendency to self-associate into hexamers which is not an absorpable form through the capillary bed

hexamers need to dissociate into monomers first before they can be absorbed

so unmodified insulin needs to be injected at least 30 mins before eating

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11
Q

4 types of insulin analogues

A

Rapid acting
Short acting
Intermediate acting
Long acting

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12
Q

If someone is on 1 unit insulin per 10g CHO, how many units of insulin is needed for a banana (typically containing 30g CHO)

A

3 units

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13
Q

Why is it important to monitor BG levels at home (list a few reasons)

A

To adjust insulin dose if needed

To see if it’s suitable to drive (5mmol/l to drive)

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14
Q

DKA occurs when blood ketones level are what or above

A

3mmol/l

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15
Q

Treatment of DKA (3)

A

IV saline
IV potassium added to saline
IV soluble insulin (i.e. short acting)

ketone levels should decrease after 2hrs

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16
Q

Name some examples of rapid acting insulin analogues

A

Insulin lispro (brand name - humalog)

Insulin aspart (brand name - novolog/novorapid)

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17
Q

Name some examples of short acting insulin (aka regular or soluble insulin) analogues

A

Brand names:

Humulin R, S
Actarapid

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18
Q

Name an example of intermediate acting analogues

A

hypurin isophane

intermediate acting insulins aka isoprene insulins or Neutral Protamine Hagedorn insulins

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19
Q

Name some examples of long acting analogues (3)

A 
Insulin glargine (brand name - Lantus)
Insulin detemir (brand name -  levemir)
Insulin degludec (brand name - tresiba)
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20
Q

Name another way of administering insulin other than injection

A

Continuous subcutaneous insulin infusion (i.e. insulin pump)

21
Q

Intermediate acting insulin is usually given with what other insulin

A

short acting

22
Q

Mode of action of rapid acting insulins (e.g. humalog, novorapid)

  • when is it given
  • how long does it take to work after injecting
  • when does its activity peak
  • how many hours overall does it last
A

immediately before a meal

onset of about 15 minutes after injection

peaks about one to two hours after injection

lasts up to five hours

23
Q

Mode of action of short acting insulins (e.g. actrapid, humullin R)

  • when is it given
  • how long does it take to work after injecting
  • when does its activity peak
  • how many hours overall does it last
A

Before meals

Onset of between 30 minutes and an hour

Peaks at 2-4hrs

lasts for approximately 8hrs

24
Q

Mode of action of intermediate acting insulins (e.g. actrapid, humullin R)

  • how long does it take to work after injecting
  • when does its activity peak
  • how many hours overall does it last
A

onset of about two hours after injection

peaks in first 8 hours

lasts between 18 and 24 hours

25
Q

Mode of action of long acting insulins (e.g. lantus, levemir)

  • how long does it take to work after injecting
  • when does its activity peak
  • how many hours overall does it last
A

Usually once or twice daily

Consistent activity from within an hour after injecting up to 24 hours, no peak activity

26
Q

How does continuous subcutaneous insulin infusion (insulin pump) work

A

Regular or continuous amount of insulin (usually in the form of a rapid-acting insulin analogue or soluble insulin), delivered by a programmable pump and insulin storage reservoir via a subcutaneous needle or cannula

can increase/decrease dose manually when needed

27
Q

Recommended first line insulin regimen for type 1 diabetics

A

Multiple daily injection basal-bolus insulin

  • rapid acting bolus insulin before meals AND
  • twice-daily long-acting basal insulin
28
Q

List the different insulin regimens (3)

A

Multiple daily injection basal-bolus insulin (one or more separate daily injections of intermediate-acting insulin or long-acting insulin analogue as the basal insulin; alongside multiple bolus injections of short-acting or rapid acting insulin before meals)

Mixed (biphasic) regimen (one/two/three insulin injections per day of short-acting mixed with intermediate-acting insulin)

Continuous subcutaneous insulin infusion

29
Q

Hypoglycaemia (an acute metabolic upset in DM) refers to an episode of BG

A

low blood glucose (<4mmol/l) with or without symptoms

30
Q

Causes of a hypo (5)

A

not having enough carbohydrate at your last meal

excessive exercise without having extra carbohydrate or without reducing your insulin dose (if you take insulin)

taking more insulin (or oral hypoglycaemics) than needed

inappropriate timing of insulin therapy

drinking alcohol on an empty stomach

31
Q

Those at risk of hypoglycaemia (4)

A

Cognitively impaired
Very young/very old
Those who have to tightly control BG
Those with malabsorptive disorders, e.g. crohn’s, coeliac

32
Q

Do most isolated hypo episodes recover spontaneously in type 1 diabetics

A

Yes, most recover even if untreated and not associated with permanent damage

33
Q

Symptoms/signs of a hypo (9)

A
  • feeling shaky/tremor
  • sweating
  • feeling hungry
  • palpitations
  • confused/drowsy
  • anxiety/irritability
  • poor concentration
  • headache
  • nausea
34
Q

Medical issues that puts you at risk of a hypo (5)

A 
Tight glycaemic control
Previous history of severe hypo
Long duration of DM
Poor injection technique
Severe liver/kidney dysfunction
35
Q

Lifestyle issues that puts you at risk of a hypo (4)

*referring to anyone in general, not just diabetics

A

Increased exercise than usual
Increasing age
Alcohol
Breast feeding

36
Q

All patients taking insulin or sulphonylureas are advised to always carry what with them incase of what

A

Carbohydrate, e.g. fruit juice

In case of a hypo

37
Q

Complications of a severe hypo untreated (3)

A

Coma
Hemiparesis
Seizures

38
Q

Emergency treatment of an episode of MILD hypoglycaemia (conscious, orientated, able to swallow)

A

15-20g of quick acting carbohydrate

  • 5 dextrosol tablets OR
  • 150 to 200ml of pure fruit juice
39
Q

Emergency treatment of an episode of MODERATE hypoglycaemia (conscious, able to swallow but confused/ disorientated)

A

If co-operative, treat like mild hypo so 15-20g of quick acting carbohydrate (150-200ml fruit juice)

If not co-operative but can swallow then
-give 1.5-2 tubes of glucose gel squeezed into mouth between teeth and gums

40
Q

Emergency treatment of an episode of SEVERE hypoglycaemia (unconscious or very aggressive)

A

Check ABC

IV glucose over 10-15 mins

41
Q

If unable to take oral carbohydrate during a hypo and you’re out of hospital, what should you take

A

1mg intramuscular glucagon

or

glucose gel

42
Q

If in hospital and go into a hypo where you’re unable to take oral carbohydrate, what should be given

A

IV glucose/ dextrose (same thing)

43
Q

After emergency treatment is given for a hypo and BG has raised to above 4, what follow up treatment should be given

A

20g of long acting carbohydrate, e.g. biscuits, bread, milk

44
Q

What does a hypo box contain (emergency treatment of a hypo) (4)

A

Fruit juice 200ml
Glucogel (glucose gel)
Dextro energy (dextrose tablets)
IV glucose

45
Q

Ways to avoid a hypo in insulin treated DM (5)

A 
Adequate BG monitoring
Rotate and check injection sites
Count carbohydrate intake
Consider change in insulin regimen
Alter insulin before and after exercise
46
Q

BG level needed to drive

A

5mmol/l

47
Q

What are the ‘sick day rules’ for an insulin treated diabetic who falls acutely ill (5)

A

NEVER stop insulin
Increase/decrease insulin dose according to BG
More frequency checks of BG
Check urine/blood for ketones
Maintain CHO intake by fluids if can’t eat, e.g. soup, milk, fruit juice with sugar free drinks in between

48
Q

What stores are broken down for energy when can’t get glucose into cells due to shortage of insulin

A

Fat, which releases free fatty acids that the liver converts to ketones

49
Q

In DKA, serum potassium is usually high due to extracellular shift of potassium but why is IV potassium given as treatment

A

Total body potassium concentration is low due to increased diuresis

Year 2 - Endocrine (21 decks)

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