Type 1 diabetes Flashcards
What is type 1 diabetes
insulin deficiency - destroyed beta cells in islet of langerhans
when is type 1 most common
before adulthood
typical features of type 1
-hyperglycaemia >11mmol/l
-ketosis
-rapid weight loss
-BMI <25
-<50yr
-FH of autoimmune disease
how often should blood glucose be monitored and when?
-four times a day including before each meal and before bed
-walking
-fasting BG before meals
-90 mins after eating
-driving
how many meals should type 1 diabetics have?
3 meals always
what is the target level for walking
5-7
what is the target level for fasting BG before meals
4-7
90 minutes after eatingwhat is the target level 90 minutes after eating
5-9
what is the target level for driving
> 5
what are the insulin regimens
1) multiple daily dose injections **basal-bolus **
2) bipharic mixture
3) continuous SC insulin infusion (insulin pump)
what is included in multiple daily injection basal-bolus insulin regimen
-basal (long/intermediate acting) OD/BD AND
-bolus (short/rapid acting) before meals
what is first line basal insulin regimen
detemir BD
What is second line basal insulin regimen
glargine OD
What is included in bipharic mixture insulin regimen
short acting mixed with intermediate insulin inj 1-3 times a day
when is continuous SC insulin infusion (insulin pump) insulin regimen given?
in adults = suffer disabling/uncontrolled hypoglyc
insulin requirements for more insulin
infection
stress
trauma
insulin requirements for less insulin
-physical activity
-intercurrent illness
-less food intake
-impaired renal function
-thyroid disorders
-coeliac disease
-addisons disease
why is insulin given by SC
if oral it will be inactivated by GI enzymes
what are the injection sites for insulin
-body areas with SC fat
-abdomen (fastest absorption sites)
-outer thigh/buttocks (slower)
why do you need to rotate sites when injecting
lipohypertropy can occur due to repeatedly inj same small area erratic absorption of insulin
what are the different types of short acting insulin?
-soluble insulin
-rapid-acting insulin
what is in soluble insulin
human + bovine/porcine
when should soluble insulin be injected?
15-30 mins before food
what is onset of soluble injection
30-60mins
what is peak action of soluble injection
1-4hr
what is duration of soluble injection
upto 9hr
types of rapid acting insulin
no LAG
-lispro
aspart
glulisine
when should rapid-acting injection be injected
immediately before meals
what is onset of rapid-acting injection
<15mins
what is duration of rapid-acting injection
2-5hr
what are the types of insulin
-intermediate-acting insulin
-long-acting insulin
what is types of intermediate-acting insulin
bisphasic isophane
biphasic aspart
lispro (isophane inj mixed with SA insulin)
what is onset of intermediate-acting insulin
1-2hr
what is peak effect of intermediate-acting insulin
3-12hr
what is duration of intermediate-acting insulin
11-24hr
what are the types of long-acting insulin
Detemir (BD)
Degludec (OD)
Glargine (OD)
what is onset of long-acting insulin
2-4DY to reach steady state
what is duration of long-acting insulin
36hr
