Type 1 diabetes Flashcards
Advise patients to aim for a fasting blood glucose ON WAKING of what?
5-7
Advise patients to aim for a fasting blood glucose throughout the day of what?
4-7
After eating, what blood glucose level should patients aim for?
Advise adults with type 1 diabetes who choose to test after meals to aim for a plasma glucose level of 5–9 mmol/litre at least 90 minutes after eating
What long-acting insulin should be offered to patients who are being initiated on a basal bolus regime?
Offer twice‑daily insulin detemir as basal insulin therapy for adults with type 1 diabetes
OR
once-daily insulin glargine or insulin detemir if twice‑daily basal insulin injection is not acceptable to the person, or once‑daily insulin glargine if insulin detemir is not tolerated
What bolus insulin should be offered to patients who are being initiated on a basal bolus regime?
Offer rapid‑acting insulin analogues injected before meals, rather than rapid‑acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes
When might a twice daily biphasic insulin regime be appropriate?
If basal bolus doesn’t fit with their lifestyle
if patients suffer from hypos
A type 1 diabetic patient who is acutely unwell with an infection in hospital has a HBA1c value of 80, what would we want to check before making changes to any medication?
We would expect blood glucose to be higher in patients who are ill however HbAlc is a measure of patients long term control. Need to check patient is actually using their insulin properly, and ask them where they inject it - are they rotating their sites of injection? If not then this can lead to decreased absorption!
Can metformin be used in patients with type 1 diabetes?
Yes - consider adding in metformin to patients with a BMI >25 kg/m2 (or 23 if south asian) and want to improve their glucose control without increasing their insulin dose.
Metformin can aid with weight loss.
Aim for a blood glucose target of X, in diabetic patients in hospital?
Aim for a target plasma glucose level of 5–8 mmol/litre for adults with type 1 diabetes during surgery or acute illness
When might we use an intravenous insulin regime in diabetic patients in hospital?
If patient is unable to eat or likely to miss more than one meal.
an acute situation is expected to result in unpredictable blood glucose levels – for example, major surgery, high‑dose steroid treatment, inotrope treatment or sepsis
insulin absorption is expected to be unpredictable, for example because of circulatory compromise.
How and how often should be screen for Diabetic kidney disease?
Ask all patients whether they have established kidney disease or no detected neuropathy, to bring in their first urine sample of the day, once a year. Then send this off to determine the ACR - albumin creatine ratio.
Start angiotensin‑converting enzyme (ACE) inhibitors and, with the usual precautions, titrate to full dose in all adults with confirmed nephropathy.
Advise adults with type 1 diabetes and nephropathy about the advantages of not following a high‑protein die
What might happen do patients following rapid improvement in glucose control?
cute painful neuropathy resulting from rapid improvement of blood glucose control in adults with type 1 diabetes
should not relax control, manage with anaglesics, pain will subside.
