management of type one diabetes Flashcards
what is person centred care?
what are different types of management available for diabetes?
what are management aims of type one diabetes?
what is STEP?
what are the outcomes of step?
what are the three TTTs for making an early diagnosis?
what are the current strategies to support people with Type 1 diabetes?
Education
Team based DSN, dietitian, doctor.
Structured education e.g. STEP (DIANE, Dose Adjustment For Normal Eating).
Person with diabetes is main team member.
Nutrition and Lifestyle management e.g. CHO counting, physical exercise
Skills training e.g. Home blood glucose monitoring, injection technique, hypos, sick day rules
Insulin- analogues, pens, pumps
what do you need to check before injecting insulin?
Right insulin – check the name.
Right dose – check strength and how much insulin to give. Check the numbers very carefully.
Right time – with food? At bedtime?
Right way – via syringe, pen or pump?
what different types of insulin are there?
what are common sites for insulin administration / technique / time?
Needle size
Location
Rotation
Technique
Time
do not recommend injecting into upper arms – due to proximity to muscle
what insulin therapy regimes are there?
Basal Bolus
Rapid (Short) Bolus acting insulin to cover CHO at meals 1 unit per 10g CHO
Basal long acting insulin as background – twice daily (sometimes once daily)
what are some current insulin regimes?
Twice daily
Rapid acting mixed with intermediate acting
Before breakfast (BB) and evening meal (BT)
Three times daily
Rapid acting mixed with intermediate acting BB
Rapid acting BT
intermediate acting at bedtime BBed
Four times daily MDI (multiple daily injections)
Short acting BB BL BT
Intermediate BBed or long acting insulin at a fixed time once daily
Assessing blood glucose control Home blood glucose monitoring
and ketone testing
Type 1 Diabetes e.g. to adjust insulin dose, prior to driving, tighten control
Continuous Glucose Monitoring
isCGM – intermittent scanning CGM eg flash
rtCGM - real time CGM – data is sent directly
Can link with insulin pump
Diabetic Ketoacidosis DKA Symptoms
Nausea & vomiting
……………………………………………………..
Abdominal pain
…………………………………………………..
Sweet smelling, “ketotic”
Breath
……………………………………………….
Drowsiness
……………………………………………….
Rapid, deep “sighing” respiration
……………………………………………….
Coma
what are sick day rules for a diabetic?
Read through patient information leaflet
NHS Grampian
Clinical Guidance
NEVER STOP insulin
Continue basal
what is the incidence of diabetic ketoacidosis occuring?
A serious acute complication of diabetes, predominantly T1DM
Can happen in T2DM (SGLT2)
Annual incidence in T1DM of 1-5%
Still significant mortality but fall from 7.96 – 0.67% in developed countries in last 20 years
what would the stages to hyperosmolaty from absolute insulin deficiency be?
what are sick day rules and DKA?
what initial investigations are done for type 1?
what is the management plan for DKA?
what are complications of dka?
what is hypoglycaemia?
what are causes of hypoglycaemia?
Too much insulin/SU
Inappropriate timing of insulin/SU
Injection site problems
Inadequate food CHO intake/fasting
Exercise
Alcohol
what groups are at risk of hypoglycaemia?
Tight glycaemic control
Impaired awareness
Cognitive impairment
Extremes of age
Malabsorption/gastroparesis
Hypoadrenalism/abrupt steroid withdrawal
Renal/hepatic impairment
Pancreatectomy
what is the treatment plan for hypoglycaemia?
what is a hypobox?
Fruit juice
Dextrose tabs
Glucogel
20% or 50% Dextrose
Hypo management protocol
what is Continuous Subcutaneous
Insulin Infusion (CSII)
how does a pump work?
what education can be found on type 1 diabetes?
