Managing Diabetes

Question 1

How often should a T1DM patient monitor blood glucose?

What are the blood glucose targets?

Answer 1

Monitor at least 4 times a day
Targets:
On waking - Fasting 5-7mmol/L
Before meals - Blood glucose 4-7mmol/L
Post meals - After 90 mins, 5-9mmol/L

• Also before driving, during illness, and if they feel hypoglycaemic

Question 2

What is DAFNE?

Answer 2

Dose Adjustment for Normal Eating programme

- Offered to type 1 diabetics around 6-12 months after diagnosis or when suitable for the patient

Question 3

What support groups are available?

Answer 3

Diabetes UK website has a support helpline

Question 4

What is the target HbA1c for an adult with T1DM?

Answer 4

• 6.5% or lower
• 48mmol/mol or lower
• If they have CKD, aim for less than 8%
• Take into account personal factors and if they have persistent hypoglycaemic episodes

Question 5

How often should HbA1c be measured?

Answer 5

Every 3-6months

Question 6

What should you advise about diet?

Answer 6

• Do not advise low glycaemic index diet
• Offer carbohydrate counting training whilst waiting for DAFNE
• Diabetes UK has lots of information
• Advise about lowering cardiovascular risk (low fat, sugar, salt, 5 a day)

Question 7

What alcohol advise should you give to a type 1 diabetic?

Answer 7

• Avoid drinking on an empty stomach
• Eat a snack before and after drinking
• Measure blood glucose regularly
• Alcohol may prolong hypoglycaemic effect of insulin so nocturnal hypoglycaemia may occur
• Wear a medic alert bracelet

Question 8

What advise should you give about exercise and physical activity?

Answer 8

• Lowers blood glucose as glucose used by muscles for energy
• Reduces CVD risk
• Helps with weight management

Question 9

What should you advise a T1DM patient doing exercise?

Answer 9

• Self monitor changes insulin or nutritional needs

- Risk of hypoglycaemia

Question 10

What should you advise about smoking?

Answer 10

Stop as it is a risk factor for CVD

Question 11

What are the sick day rules for a T1DM patient?

Answer 11

• Never omit or stop insulin
• Check blood glucose more frequently, every 1-2hrs even through the night, adjust blood glucose accordingly
• Check urine ketones
• Maintain normal meal pattern, and replace with sugary drinks if needed
• Aim to drink 5 pints of water a day
• Seek urgent medical advice if they are violently sick, drowsy or unable to keep fluids down

Question 12

What should you assess annually?

Answer 12

Cardiovascular risk factors -

• Lifestyle
• Waist circumference
• Blood glucose control
• Blood pressure
• Albuminuria
• Full lipid profile
• FHx of CVD

Question 13

When should you consider antihypertensive treatment in a diabetic?

Answer 13

If there is no albuminuria, or features of metabolic syndrome - T1DM BP > 135/85

If there is albuminuria, or 2 or more features of metabolic syndrome - T1DM > 130/80

Question 14

When should you offer a statin?

Answer 14

In a T1DM patient with no CVD if:

• > 40 years old
• Had diabetes over 10 years
• Established neuropathy
• Has other CVD risk factors