Treatment of T1DM Flashcards
Outline the normal glucose/insulin physiology
- Insulin is secreted at a low basal rate which accounts for 50% of insulin produced
- Post-prandial insulin is secreted in relation to post-meal glucose
(treatments aim to replicate this interaction)
What is the first line regime for T1DM treatment ?
Basal-bolus regime - this is a rapid acting insulin given before having a meal and a long acting insulin given once or twice per day
What are the rapid acting insulins ?
Humalog (insulin lispro), Novorapid or Apidra (HAN-solo)
What are the long-acting insulin analogues ?
Lantus or levemir
What are the short acting insulins ?
Humulin S, Actrapid, Insuman rapid (HIA to remember them)
What are the intermediate acting insulins?
Insulatard, Humulin I (isophane human), Insuman basal
What are the rapid acting analogue intermediate mixtures ?
Humalog mix 25/50 or Novomix 30
What are the short acting intermediate mictures ?
Humulin M3. Insuman comb 15,25,50
What is the importance of carb counting ?
Because peoples carb intake varies from meal to meal so need to tailor there rapid/short acting insulin intake per meal to the carbs in that meal
What is the ratio of units of insulin to grams of carb ?
1 unit to 10grams of carb
What is an insulin pump ?
- Medical device which gives a continuous administration of short acting insulin S/C
- Delivers a background insulin dictated by basal rate
What are the different ways in which you can evaluate metabolic control of diabetes ?
- Home blood glucose (fingerstick tests)
- Urine testing (glucose/ketones)
- Glycated haemoglobin (HBA1c)
- Continuous glucose monitor
What is a draw back of fingerstick tests in blood glucose monitoring ?
They only provide a snapshot of control not able to see the whole picture with them
What is a benefit of HBA1c in blood glucose monitoring ?
Provides a measure of average blood glucose over a prolonged time - 6-8 weeks
What are some of the limitations/problems encountered with insulin therapy ?
No therapy is able to replicate normal human insulin physiology
Normal human pancreatic insulin secretion - is direct into the portal blood stream, rapidly prevents post-meal hyperglycaemia and is rapidly cleared
Insulin therapies - Injected in S/C tissue. peak too slow to prevent post-meal hyperglycaemic spike, have a slow clearance
What are some of the factors which effect insulin absorption/action ?
- Injection accuracy
- Leakage at injection site
- Lipohypertrophy developing and affecting absorption at site
What are some of the safety issues with insulin ?
- Potential wrong dosage given - due to misreading e.g. 10U can be read as 100 and patient is then given 100 units. This is why abbreviations such as U and IU are never used
- Insulin omission e.g. if a patients unwell
- Wrong insulin type given - the names all look very similar e.g. Humalin I and Humalin S
What are the principles of insulin dose adjustment ?
- Review glycaemic control and adjust to optimise control
- Insulin adjustment can precipitate hypoglycaemia
- Do not omit insulin if hypoglycaemic, treat the hypo and administer insulin as usual
What are the blood glucose targets in insulin treatment ?
- Pre-prandial - 4-7mmol/L
- Post meal - < 10 mmol/L
- HBA1c 48 mm
What are the key points about insulin administration ?
- Verify amount of insulin with patient or if not possible with a colleague as you must ALWAYS have 2nd independent check of insulin doses
- Only use specific insulin syringes
- Glucose should be used for all IV insulin infusions except patients admitted with DKA
Note the I, S and M when talking about Humulin stand for short, intermediate and mixed
.
When do you give IV insulin ?
- DKA
- Role in hyperosmolar hyperglycaemic state (HHS)
- Acute illness
- Fasting patients who are unable to tolerate oral intake
What monitoring is required for patients receiving IV insulin ?
- Hourly blood glucose monitoring - aim for a BG of 5-12 mmol/L
- Check ketones if BG > 12
- Check Us and Es at least daily
