Type 1 diabetes

Question 1

What do all patients with type 1 diabetes require?

Answer 1

Insulin therapy

Question 2

How many insulin regimes are there?

Answer 2

Many

Question 3

When does type 1 diabetes usually occur

Answer 3

From childhood

Question 4

What are some symptoms of diabetes

Answer 4

Increased thirst

Frequent urination

Hyperglycaemia (random glucose test = above 11mmol/l)

Extreme hunger

Unintended weight loss in type 2

Irritability and mood changes

Fatigue and weakness

Blurred vision

Increased UTIs

Question 5

What are the ideal blood glucose levels

Answer 5

4-7 = before meals

5 to 7 = I wake at 7 (waking)

5-9 = I dine at 9 (after food)

More than 5 = 5 to drive

Random blood glucose = <11

Hba1c = Equal to or less than 48

Question 6

When might metformin be added to insulin regimes in type 1?

Answer 6

Metformin added to glucose may benefit patients with BMI of more than 25 (or 23 of those from south Asian ethnicity)

Question 7

What is the benefit of insulin

Answer 7

Increases glucose uptake

Question 8

What is the natural secretion profile

Answer 8

Basal - slow and steady continuous release of insulin that controls insulin continuously

Bolus: produced in response to food and drink

Question 9

Is insulin inactivated by GI enzymes?

Answer 9

Yes - SC route most ideal

Question 10

Where is insulin administered

Answer 10

In the area of most fat - abdomen, outer thigh or buttock

Question 11

What does injecting the same area lead to?

Answer 11

Lipohypertrophy = leads to poor glycaemic control = rotate site

Question 12

Where should insulin be stored

Answer 12

Fridge 2-8 degrees

Question 13

What should all patients on long term insulin do (type 1 or type 2)

Answer 13

Inform the DVLA

Question 14

What do the DVLA say to carry when driving in any case of diabetes

Answer 14

Capillary blood-glucose meter and test strips

Question 15

According to DVLA, how often should the blood glucose be checked

Answer 15

Blood-glucose concentration should be checked no more than 2 hours before driving and every 2 hours while driving.

Question 16

What should you do if the glucose levels fall below 5 whilst driving

Answer 16

Take a snack

Question 17

What should happen if the driver has a hypo episode when driving

Answer 17

If already driving, the driver should stop the vehicle in a safe place as soon as possible, and turn off the engine, remove the keys from the ignition, and move from the driver’s seat; drivers should wait until 45 minutes after their blood-glucose has returned to normal (at least 5 mmol/litre), before continuing their journey.

Question 18

What does alcohol do when checking for hypoglycaemia

Answer 18

Makes the signs of hypoglycaemia less clear

Can cause delayed hypoglycaemia

Drink alcohol only in moderation, and when accompanied by food.

Question 19

Can insulin cause weight gain

Answer 19

Yes

Question 20

When can insulin requirements increase

Answer 20

Pregnancy, puberty, infection, stress and trauma.

Question 21

When can insulin requirements decrease

Answer 21

Celiac disease, hepatic impairment and Addison’s disease.

Question 22

Summary of insulins

Answer 22

Question 23

Basal bolus routine

Answer 23

Question 24

Once daily regime

Answer 24

Question 25

Mixed biphasic routine

Answer 25

Question 26

Continuous subcutaneous insulin

Answer 26

Question 27

What should insulins look like

Answer 27

Clear

Humulin 1 and isophane look white/cloudy

Question 28

Should insulin be withdrawn from cartridges?

Answer 28

No they should not

Question 29

Should the words units or international units be abbreviated?

Answer 29

No

Question 30

When converting from bovine to human insulin, what should you do?

What about porcine to human?

Answer 30

Reduce dose by 10% to avoid hypo

Porcine to human = no conversion needed

Question 31

What should be done in elective surgery for minor procedures with good glycaemic control?

Answer 31

On the day before the surgery, the patient’s usual insulin should be given as normal, other than once daily long-acting insulin analogues, which should be given at a dose reduced by 20 %.

Question 32

What to do with elective surgery with major procedure or poor glycaemic control

Answer 32

On the day before surgery, once daily long-acting insulin analogues should be given at 80 % of the usual dose; otherwise, the patient’s usual insulin should be given as normal;

On the day of surgery and throughout the intra-operative period, once daily long-acting insulin analogues should be continued at 80 % of the usual dose; all other insulin should be stopped until the patient is eating and drinking again after surgery

Question 33

What should be given during pregnancy for insulins?

Answer 33

In pregnancy give insulin aspart (novorapid) and insulin lispro (Humalog) (short acting)

Isophane insulin is the first choice for long-acting insulin during pregnancy.