Management of Type I DM Flashcards
What sort of educational strategies can be employed to support people with Type I DM?
Team based - DSN, practice nurse, dietician, podiatrist, doctors
Structured education - dose adjustment for normal eating etc
Why can insulin not be administered orally?
IT is a polypeptide which is deactivated by the GI tract
How long before eating is insulin given?
30 minutes
Do all insulins act over the same period of time?
No, they may be rapid, short, intermediate or long acting
What things should be taken into account when selecting the most appropriate therapy for a DM patient?
Patient choice
Lifestyle
Device
Give some examples of insulin administration routines
Basal bolus - suitable for flexible lifestyle
Better for shift workers
Basal long acting to cover background and rapid or short acting to cover CHO at meal times
Twice daily mix - works best if lifestyle is fixed with regular meals
Minimises injections
Rapid acting mixed with intermediate acting
What is a continuous subcutaneous insulin infusion (CSII)
An insulin pump which secretes insulin subcutaneously via a cannula. Provide a continuous infusion with mealtime boluses
What adjustments can/may have to be made by the patient to help with type I treatment?
Lifestyle Exercise Driving Alcohol Conception Drugs Holidays Employment
What is a severe complication of hyperglycaemia?
Diabetic ketoacidosis
What are hypo and hyperglycaemia examples of?
Acute metabolic upsets
What must the BG level be for a diagnosis of hypoglycaemia? Are symptoms necessary?
Give some reasons for hypoglycaemia
Food - too little/wrong type
Activity - during/after
Insulin - dose/injection technique
Alcohol
What can an inability by the patient to perceive the normal warning signs of hypoglycaemia be associated with?
Recurrent severe hypoglycaemia
Long duration of the disease
Overly tight control
Loss of sweating/tremor
How should hypoglycaemia be treated?
BG levels must be returned to safe levels and all patients should be advised to carry carbohydrates with them
In what case should glucagon treatment for hypoglycaemia be avoided?
Where the hypoglycaemia is caused by sulphonylureas
What should be addressed after a patient has recovered from a hypoglycaemic attack?
Wrong regimen? - dose/insulin Control and monitoring Hypo unawareness Driving/work Food/activity/insulin Injection sites
What recommendations should be made in respect to driving and hypoglycaemia?
Patients should be advised to check their BG within 2 hours of driving and should always carry carbohydrate with them
There must be no more than 1 severe episode in a year
What is diabetic ketoacidosis?
Results from the breakdown of fat because of a lack of insulin. The lack of insulin prevent the cells from up taking glucose and therefore the body has to turn to fat stores to provide energy - ‘starvation in the midst of plenty’
It is usually accompanied by a high level of plasma glucose
May be called by infection/severe stress
What three excesses combine in diabetic ketoacidosis?
Glucose
Ketones
Acidosis
What are some symptoms of diabetic ketoacidosis?
Dehydration Thirst Abdominal pain Acetone on breath Nausea/vomiting Tachycardia and low BP
What are the principles of management of DKA in HDU?
Measure BG/U’s & E’s/ketones/bicarbonate/venous blood gases
GIVE IV saline
Give IV insulin
Give IV potassium in saline
May need antibiotics
May need LMWH, NG tube
Mortality rate 2%
What are the basic treatment aims in facilitating the long term health and wellbeing of DM patients?
Optional BG control
- reduces microvascular disease e.g. retinopathy
- improves pregnancy outcome
Optimal BP control
- reduce nephropathy
Manage cardiovascular risk factors e.g. smoking, LDLs
Screen for early detection of complications - feet, eyes, kidneys
What is the goal in terms of designing the optimum insulin regime for the patient?
To as closely as possible match the normal physiological profile of insulin seen in the non-diabetic individual
Describe sensor augmented insulin pumps
Pumps the provide full integration of insulin delivery with real time BG monitoring - closed loop
Potential to act like an artificial pancreas
Outline whole pancreas transplant for DM patients
Highly limited by donors
Often in combination with kidney transplant
Requires immunosupression
Usually curative (DM) but very high risk surgery
What is the main indication for islet cell transplantation? Outline the treatment
Severe hypoglycaemia with unawareness
Often requires multiple transplants to achieve insulin dependence
Limited by donor availability
Requires lifelong immunosupression
What are some potential future methods of preventing DMT1?
Vaccination to prevent autoimmune destruction of Beta cells
Treatment with oral or injected insulin before DMT1 develops
