T1DM

Question 1

overarching structure of T1DM counselling

Answer 1

focused hx
red flags
break bad news of Dx
explain disease
explain symptoms
explain treatment principles
monitoring - state mx lifelong & self-monitoring
lifestyle adaptations
precautions (school, lifeguards)
career restrictions (military)
safety net
diabetes UK

Question 2

focussed hx

Answer 2

polyuria // polydipsia
weight loss
excessive tiredness
recurrent infections
2ry enuresis

Question 3

T1DM red flags

Answer 3

DKA - persistent vomiting/diarrhoea // abdo pain // confusion // dehydration

Question 4

What are some of the problems associated with T1DM (4)

Answer 4

Vision Problems
Kidney problems
Heart problems
High blood pressure

Question 5

What are the causes of T1DM (2)

Answer 5

Mixture of genes + viral trigger

Question 6

What should we tell the Pt in regards to the management of T1DM

Answer 6

Regular Injections of Insulin (not PO as stomach digests insulin)

Lifestyle Changes (Sugary foods / exercise / weight loss)

Keeping an eye on blood sugar levels - regular self testing

Question 7

What can we offer patient for those with T1DM (think maintenance)

Answer 7

Regular blood tests + check up screens - 3-6 monthly

Clinics - diabetes team, consultant referral if needed

Question 8

two main options of insulin delivery

Answer 8

basal-bolus: one daily injection at same time + injection before major meals

insulin pump

Question 9

counsel on insulin pump

Answer 9

criteria on NHS: >12 & difficulty controlling levels already

pushes insulin through a cannula - replace every 2-3 days

pros - better sugar control, more flexibility & fewer injections

cons - steep learning curve, on all the time, blockage, infection (small)

tethered pump - insulin replaced from pump // attached to waist // tube connects pump to cannula

patch pump (May) - remotely controlled // patch thrown away once finished

Question 10

safety net for

Answer 10

hypoglycaemia - lucozade & biscuits