Type 1 diabetes Flashcards
What do all patients with type 1 diabetes require?
Insulin therapy
How many insulin regimes are there?
Many
When does type 1 diabetes usually occur
From childhood
What are some symptoms of diabetes
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
What are the ideal blood glucose levels
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
When might metformin be added to insulin regimes in type 1?
Metformin added to glucose may benefit patients with BMI of more than 25 (or 23 of those from south Asian ethnicity)
What is the benefit of insulin
Increases glucose uptake
What is the natural secretion profile
Basal - slow and steady continuous release of insulin that controls insulin continuously
Bolus: produced in response to food and drink
Is insulin inactivated by GI enzymes?
Yes - SC route most ideal
Where is insulin administered
In the area of most fat - abdomen, outer thigh or buttock
What does injecting the same area lead to?
Lipohypertrophy = leads to poor glycaemic control = rotate site
Where should insulin be stored
Fridge 2-8 degrees
What should all patients on long term insulin do (type 1 or type 2)
Inform the DVLA
What do the DVLA say to carry when driving in any case of diabetes
Capillary blood-glucose meter and test strips
According to DVLA, how often should the blood glucose be checked
Blood-glucose concentration should be checked no more than 2 hours before driving and every 2 hours while driving.
What should you do if the glucose levels fall below 5 whilst driving
Take a snack
What should happen if the driver has a hypo episode when driving
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.
What does alcohol do when checking for hypoglycaemia
Makes the signs of hypoglycaemia less clear
Can cause delayed hypoglycaemia
Drink alcohol only in moderation, and when accompanied by food.
Can insulin cause weight gain
Yes
When can insulin requirements increase
Pregnancy, puberty, infection, stress and trauma.
When can insulin requirements decrease
Celiac disease, hepatic impairment and Addison’s disease.
Summary of insulins
Basal bolus routine
Once daily regime
Mixed biphasic routine
Continuous subcutaneous insulin
What should insulins look like
Clear
Humulin 1 and isophane look white/cloudy
Should insulin be withdrawn from cartridges?
No they should not
Should the words units or international units be abbreviated?
No
When converting from bovine to human insulin, what should you do?
What about porcine to human?
Reduce dose by 10% to avoid hypo
Porcine to human = no conversion needed
What should be done in elective surgery for minor procedures with good glycaemic control?
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 %.
What to do with elective surgery with major procedure or poor glycaemic control
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
What should be given during pregnancy for insulins?
In pregnancy give insulin aspart (novorapid) and insulin lispro (Humalog) (short acting)
Isophane insulin is the first choice for long-acting insulin during pregnancy.
