Treatment of T1DM Flashcards
What are the different devices associated with insulin administration?
Syringe
Disposable pen
Re-usable cartiridge pen
Insulin pump
What are the aims of therapy in T1DM treatment?
Prevent hyperglycaemia
Redice chronic complications
Avoid hypoglycaemia
What are the symptoms of hyperglycaemia?
Polydipsia, fatigue, blurred vision, weight loss, polyuria, nocturia, fungal infections
Cognitive, mood state, information processing, working memory
Risk of DKA
What are the symptoms of hypoglycaemia?
Pallor Sweating Tremor Palpitations Confusion Nausea Hungar Cognitive: tense, fatigue, information processing
What chronic complications are you trying to avoid in diabetes?
Avoidance of microvascular disease
Avoidance of macrovascular disease
Avoidance of acute metabolic complications - DKA, SHG
Reduced psychosocial morbidity
What are rapid acting insulin analogues?
Humalog
Novorapid
What are short acting human insulins?
Actrapid
What are long acting insulin analogues?
Lantus
Levemir
Whar are common mixed insulin therapies?
Humalog Mix25
Novomix30
How are subcutaneous injections calculated?
0.3 units/kg body weight
Divide it around 50% prandial, 50% basal
What is the glucose measurement target pre meals?
3.9-7.2 mmol/l
What is the target glucose levels 1/2 hours after begining a meal?
Less than 10 mol/l
What is the onset, peak and duration of action of insulin analogues?
Onset: 10-15 mins
Peak: 60-90 mins
Duration: 4-5 hours
What is the onset, peak and duration of soluable human insulin?
Onset: 30-60 mins
Peak: 2-4 hours
Duration: 5-8 hours
What is advanced carbohydrate counting?
Synchronizing the amount of insulin taken to amount of carbohydrate consumed
Who is advanced carbohydrate counting suitable for?
Those on multiple daily injections
Those on continous subcut insulin infusion pumps
How is carbohydrate amount estimated in food?
Food measurement (weight, volume) Visual questions Food composition tables Food labels Websites Other technologies
What is an insulin pump?
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
How can metabolic control be evaluated?
Home blood glucose monitoring
Urine testing (glucose/ ketones)
Glycated haemaglobin (HbA1c)
Continous glucose monitor
How does haemaglobin beomce glycated?
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
What are the HbA1c targets?
48 mmol/mol
53 mmol/mol
58 mmol/mol
What factors effect insulin absorption/action?
Temperature
Injection site
Injection depth
Exercise
How can insulin be used unsafely?
Wrong dose
Insulin ommision
Wrong insulin type
What should be taken into account when prescribing insulin?
Patients usual regimen and dose Blood glucose monitoring Ketone monitoring Sepsis/ acute illness Steroid therapy Age/ lifestyle
When is IV insulin given?
DKA
HHS
Acute illness
Fasting patients who are unable to tolerate oral intake
