Treatment of Type 1 Diabetes

Question 1

What are the glucose targets for type 1 diabetes?

Answer 1

• HbA1c <53mmol/L
• Before meals - 5.5-7mmol/L
  -Before other meals - 4.5-7.5mmolL
• Before bed - 6.5-8mmol/L

Question 2

What are different methods of glucose monitoring for type 1 diabetes?

Answer 2

• Continuous glucose monitoring - sensor inserted under the skin to measure glucose. It can measure glucose every 5 min or every 15mins (Freestyle libra)

Question 3

What are the blood glucose thresholds for type 1 diabetics?

Answer 3

Low threshold = 4mmolL
High threshold = 10mmolL
However it varies for individual patients

Question 4

What are the different modes of delivery for insulin?

Answer 4

• Pens,
• Basal bolus (can be done with carbohydrate counting)
• BD mix regime (can be done with carbohydrate counting)
• Continuous insulin therapy

Question 5

Name a short acting, intermediate acting and long acting insulin

Answer 5

• Short = actrapid
• Intermediate = Isophane insulin
• Long acting = insulin detemir

Question 6

What are the sick day rules for type 1 diabetics?

Answer 6

Make sure to measure blood ketones regularly but never stop taking insulin

Question 7

What is the management of DKA?

Answer 7

• Normal saline if dry,
• |Insulin at 0.1unit/kg/hour,
• Monitor potassium carefully as insulin will drive potassium into the cells

Question 8

What is the management of hyperosmolar hyperglycaemic state?

Answer 8

• Fluid replacement and monitor potassium levels.
• Insulin
  VTE prophylaxis due to hyperviscosity

Question 9

What are the symptoms of hypoglycaemia

Answer 9

Autonomic - Sweating, trembling, pounding heart, hunger and anxiety,
Neuroglycopenic - Delirium, drowsiness, speech difficulty, inability to coordinate, poor concentration

Question 10

What are the causes of hypoglycaemia?

Answer 10

• Excess insulin,
• Increased sensitivity to insulin (exercise, weight loss)
• Reduced carb intake or
• increased metabolic demand
• Reduced gluconeogenesis (alcohol, CKD or liver disease)
• Increased glucose variability
• Reduced ability to detect hypoglycaemia (sleep, dementia inadequate monitoring)

Question 11

What is the management of hypoglycaemia?

Answer 11

• Remember 4 is the floor so treat anyone under 4mmol/L. Give 150ml of not-diet coke or fruit juice. Remember to continue insulin… otherwise glucose wont get into cells.
• If unconscious then give 150mL of 10% dextrose over 15min. IV dextrose or IM glucagon