T1DM_Flashcards
What are the three types of insulin therapy for T1DM?
- Multiple Daily Injection Basal-Bolus
- Continuous Subcutaneous Insulin Infusion (insulin pump therapy)
- One, Two or Three Insulin Injections Per Day
What is Multiple Daily Injection Basal-Bolus insulin therapy?
Injections of short-acting insulin or rapid-acting insulin analogue before meals, with 1 or more separate daily injections of intermediate acting insulin or long-acting insulin analogue
What is Continuous Subcutaneous Insulin Infusion (insulin pump therapy)?
Programmable pump and insulin storage device that gives regular or continuous amounts of insulin (usually rapid-acting insulin or short-acting insulin) by a subcutaneous cannula
What is the regimen for One, Two or Three Insulin Injections Per Day?
Injections of short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin
What insulin therapy should be offered from diagnosis?
Multiple daily injection basal-bolus insulin regimens
What is considered if multiple daily injection basal-bolus insulin regimens are inappropriate?
Continuous subcutaneous insulin infusion (CSII or pump therapy)
What dietary management is recommended for T1DM?
Offer level 3 carbohydrate counting education from diagnosis and to family members
How often should blood glucose and HbA1c be monitored?
Routinely perform at least 5 capillary glucose tests per day
What are the blood glucose targets for fasting plasma glucose and other times?
4-7 mmol/L
What is the blood glucose target after meals?
5-9 mmol/L
What is the blood glucose target if driving?
> 5 mmol/L
Who should be offered ongoing real-time continuous glucose monitoring with alarms?
Children with frequent severe hypoglycaemia, impairment awareness of hypoglycaemia with adverse consequences, inability to recognise or communicate symptoms of hypoglycaemia
What is the HbA1c target?
< 48 mmol/L (6.5%)
What should be offered for blood ketone monitoring?
Offer blood ketone testing strips and a meter and advise testing for ketonaemia if they are ill or hyperglycaemic
What psychological and social support should be offered?
Offer ongoing access to mental health services
What lifestyle advice should be given?
Encourage healthy, balanced diet and regular exercise
What complications should be monitored annually from 12 years?
Diabetic retinopathy, nephropathy, and hypertension
When should thyroid disease be monitored?
At diagnosis and annually until transfer to adult services
What are the symptoms of DKA?
Nausea/vomiting, abdominal pain, hyperventilation, dehydration, reduced consciousness
What is the first-line medical treatment for hyperthyroidism?
Carbimazole or propylthiouracil
What is DKA?
A complication of diabetes where the blood sugars get very high
What are the features of DKA?
Drowsiness, abdominal pain, nausea
Why is DKA important?
It can lead to severe dehydration
What are the steps in the acute management of DKA?
Giving fluids and insulin to get the blood glucose back to a healthy range
What factors can lead to an episode of DKA?
Intercurrent illness (e.g. viral infections leading to increased insulin demand)
What advice should be given on managing intercurrent illness?
Increased insulin demand management
What should be arranged for a patient after a DKA episode?
See diabetes specialist to discuss treatment
What support organization can help with diabetes?
Diabetes UK
How should you explain the diagnosis of hyperthyroidism?
A condition where the body is unable to control the sugar levels in the blood
How common is hyperthyroidism?
It is reasonably common and well understood
What does the management of hyperthyroidism involve?
Regular self-monitoring of glucose levels (using skin prick) and taking insulin injections
What is the importance of good blood glucose control?
It helps prevent complications such as kidney and blood vessel damage
How can you identify DKA?
Look for symptoms such as nausea, vomiting, abdominal pain, hyperventilation, dehydration, and reduced consciousness
What is the importance of regular exercise and a balanced diet in managing diabetes?
They help maintain good blood glucose control and overall health
