T1DM Day to Day Management

Question 1

What involved in a care plan?

Answer 1

Education
Nutritional advice
Insulin therapy/dose adjusting
Self monitoring
Avoiding hypos/maintaining hypo awareness
Family planning
Complication monitoring
CV risk + management
Communications

Question 2

What is DAFNE?
Education

Answer 2

Dose-adjustment for normal eating
Education programme
6-12months after diagnosis

Question 3

What does DAFNE help to reduce?

Answer 3

Time spent with high blood glucose levels
Blood glucose levels
Serious hypos

Question 4

How should diet be managed?

Answer 4

Should NOT follow low glycaemic index diets
Carbohydrate counting
Referral to dieticians
Alcohol intake

Question 5

What is important when doing exercise?

Answer 5

Make sure you’re monitoring + taking glucose

Question 6

How do you manage driving?

Answer 6

Must report to DVLA
Do NOT drive glucose <5mmol/L
4-5mmol/L have small snack
<4mmol/L treat hypo + don’t drive till 45mins in range

Question 7

Why is it important to change injection site?

Answer 7

Avoid lipohypertrophy
= leads to unpredictable + delayed absorption = hypo/hyper

Question 8

How do you store insulin?

Answer 8

Store in fridge
Allow to come to RT before using
Keep at least one vial/cartridge
Protect from light + excessive heat exposure

Question 9

What are the Sick Day rules?

Answer 9

Keep taking insulin
May need more = increase testing
Drink plenty of sugar free drinks
Check for ketones

Question 10

What does hypoglycaemia result from?

Answer 10

Imbalance between glucose supply, glucose utilisation + current insulin levels

Question 11

What are the symptoms of hypos?

Answer 11

Sweating
Palpitations
Shaking
Hunger
Confusion
Drowsiness
Headache
Nausea
Incoordination

Question 12

What are the risk factors for hypos?

Answer 12

Increased exercise
Alcohol
Food malabsorption
Impaired awareness
AKI
Renal failure
Breast feeding

Question 13

What do you do if it is mild/moderate hypo?

Answer 13

1. 15-20g quick acting carbohydrate/200ml fruit juice with 3-4 teaspoons of sugar
2. No co-operative but safe to swallow = 40% glucogel squeezed into mouth between teeth + gums

Question 14

What do you do if it is a severe hypo?

Answer 14

1. Check ABC, stop IV insulin + call doctor
2. Give IV glucose over 15mins as 75ml 20% glucose or 150ml as 10% glucose or 1mg glucagon IM

Question 15

How much glucogel do you give in a hypo?

Answer 15

2 full tubes

Question 16

How much juice do you give in a hypo?

Answer 16

150-200ml

Question 17

How much fast-acting glucose shot do you give in a hypo?

Answer 17

60ml

Question 18

How much glucose tabs do you give in a hypo?

Answer 18

4-5

Question 19

What helps to quantify hypo awareness?

Answer 19

Gold Score
Clarke score

Question 20

How is family planning managed?

Answer 20

Folic acid 5mg OD
Referral to pre-natal/gestational diabetes clinic ASAP

Question 21

What is the conventional insulin regime?

Answer 21

2/3 injection regime
Basal intermediate acting = twice a day
+ short acting at least twice

Question 22

Who is closed loop systems for?

Answer 22

Option for managing blood glucose levels in type 1 diabetes

Question 23

What are the oral add ons?

Answer 23

Metformin = improve body weight + lipid profile
GLP-1 = small reduction in HbA1c + weight reduction
SGLT2 = improvements in HbA1c + body weight