Treatment of T1DM

Question 1

What are the different devices associated with insulin administration?

Answer 1

Syringe
Disposable pen
Re-usable cartiridge pen
Insulin pump

Question 2

What are the aims of therapy in T1DM treatment?

Answer 2

Prevent hyperglycaemia
Redice chronic complications
Avoid hypoglycaemia

Question 3

What are the symptoms of hyperglycaemia?

Answer 3

Polydipsia, fatigue, blurred vision, weight loss, polyuria, nocturia, fungal infections
Cognitive, mood state, information processing, working memory
Risk of DKA

Question 4

What are the symptoms of hypoglycaemia?

Answer 4

Pallor
Sweating
Tremor
Palpitations
Confusion
Nausea
Hungar
Cognitive: tense, fatigue, information processing

Question 5

What chronic complications are you trying to avoid in diabetes?

Answer 5

Avoidance of microvascular disease
Avoidance of macrovascular disease
Avoidance of acute metabolic complications - DKA, SHG
Reduced psychosocial morbidity

Question 6

What are rapid acting insulin analogues?

Answer 6

Humalog

Novorapid

Question 7

What are short acting human insulins?

Answer 7

Actrapid

Question 8

What are long acting insulin analogues?

Answer 8

Lantus

Levemir

Question 9

Whar are common mixed insulin therapies?

Answer 9

Humalog Mix25

Novomix30

Question 10

How are subcutaneous injections calculated?

Answer 10

0.3 units/kg body weight

Divide it around 50% prandial, 50% basal

Question 11

What is the glucose measurement target pre meals?

Answer 11

3.9-7.2 mmol/l

Question 12

What is the target glucose levels 1/2 hours after begining a meal?

Answer 12

Less than 10 mol/l

Question 13

What is the onset, peak and duration of action of insulin analogues?

Answer 13

Onset: 10-15 mins
Peak: 60-90 mins
Duration: 4-5 hours

Question 14

What is the onset, peak and duration of soluable human insulin?

Answer 14

Onset: 30-60 mins
Peak: 2-4 hours
Duration: 5-8 hours

Question 15

What is advanced carbohydrate counting?

Answer 15

Synchronizing the amount of insulin taken to amount of carbohydrate consumed

Question 16

Who is advanced carbohydrate counting suitable for?

Answer 16

Those on multiple daily injections

Those on continous subcut insulin infusion pumps

Question 17

How is carbohydrate amount estimated in food?

Answer 17

Food measurement (weight, volume) 
Visual questions
Food composition tables
Food labels
Websites
Other technologies

Question 18

What is an insulin pump?

Answer 18

Medical device that continously administers short acting insulin subcutaneously
Delivers background insulin dictated by basal rate
Deliver manually activated bolus of insulin to coover meals

Question 19

How can metabolic control be evaluated?

Answer 19

Home blood glucose monitoring
Urine testing (glucose/ ketones)
Glycated haemaglobin (HbA1c)
Continous glucose monitor

Question 20

How does haemaglobin beomce glycated?

Answer 20

Non-enzymatic glycation of haemaglobin on exposure to glucose
Increases in a predictable way in response to prevailing glucose
Measure of average blood glucose over a pronolged period of time

Question 21

What are the HbA1c targets?

Answer 21

48 mmol/mol
53 mmol/mol
58 mmol/mol

Question 22

What factors effect insulin absorption/action?

Answer 22

Temperature
Injection site
Injection depth
Exercise

Question 23

How can insulin be used unsafely?

Answer 23

Wrong dose
Insulin ommision
Wrong insulin type

Question 24

What should be taken into account when prescribing insulin?

Answer 24

Patients usual regimen and dose
Blood glucose monitoring
Ketone monitoring
Sepsis/ acute illness
Steroid therapy
Age/ lifestyle

Question 25

When is IV insulin given?

Answer 25

DKA
HHS
Acute illness
Fasting patients who are unable to tolerate oral intake