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ENDOCRINE > Type 1 Diabetes Management > Flashcards

Type 1 Diabetes Management Flashcards

1
Q

When was Insulin first isolated and by who?

A

1922

Banting & Macleod

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2
Q

In what decade were the short acting insulin analogues first created?

A

1990s

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3
Q

When were basal analogue insulins first introduced?

A

2000s

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4
Q

What devices are available to administer insulin?

A

Insulin Syringe (increments are insulin units)
Disposable Pen
Re-usable cartridge Pen
Continuous Subcutaneous Insulin Infusion pump (CSII)

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5
Q

What symptoms commonly indicate hyperglycaemia?

A 
Thirst
Tiredness
Toilet (polyuria)
Weight loss
Nocturia (going to toilet in the night)
fungal infections
Blurred Vision
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6
Q

How does hyperglycaemia affect cognitive function?

A
  • affects mood state
  • compromises information processing
  • impaired working memory
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7
Q

What serious condition is a hyperglycaemic patient at risk of?

A

Diabetic ketoacidosis (DKA)

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8
Q

List the main symptoms of hypoglycaemia

A 
Pallor
sweating
tremor
palpitations
confusion
nausea
hunger
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9
Q

How can hypoglycaemia affect cognitive function?

A

Tense-tiredness
Compromised information processing
Impaired working memory
Coma

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10
Q

What percentage of insulin released is basal?

A

50%

=> the other 50% = post prandial

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11
Q

Humalog, NovoRapid and Apidra are examples of what type of insulin preparation?

A

Rapid-acting analogue

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12
Q

Give examples of short-acting insulin

A

Humulin S (Human insulin)
Actrapid
Insuman Rapid

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13
Q

Give examples of intermediate acting insulin

A

Insulatard
Humulin I (human insulin)
Insuman Basal

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14
Q

Give examples of Long acting insulin preparations

A

Lantus

Levemir

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15
Q

Humalog Mix 25/50 and Novomix 30 are what type of pre-mixed insulin?

A

Rapid-acting analogue/Intermediate Mixture

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16
Q

Humulin M3 and Insuman Comb 15/25/50 are types of what pre-mixed insulin?

A

Short-acting/Intermediate Mixture

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17
Q

What insulin regimen aims to mimic normal endogenous insulin production?

A

Basal bolus insulin regimen

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18
Q

Why should most patients with T1DM use insulin analogues to manage their condition?

A

to reduce hypoglycaemia risk

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19
Q

If a patient presents to hospital with DKA, how should you begin to reintroduce their insulin once their glucose in stable?

A

Start at 0.3 units/kg body weight

Divide it so that 50% = prandial and 50% = Basal

20
Q

What should a T1DM target blood glucose prior to a meal be?

A

Rougly 4-7mmol/l

21
Q

What should a T1DM target blood glucose be 1-2 hours after the beginning of a meal?

A

<10mmol

22
Q

A large percentage of Type 1 Diabetics require twice daily long-acting analogue insulin. TRUE/FALSE?

A

TRUE

at least 50-80% require this

23
Q

What two types of insulin are usually used post-prandially?

A 
Rapid-acting analogues
Short acting (soluble human insulin)
24
Q

What is the onset, the peak action and the duration of rapid-acting analogue insulins used with meals?

A

Onset of action 10-15 mins

Peak action 60-90 mins

Duration 4-5 hrs

25
Q

What is the onset, the peak action and the duration of short-acting soluble insulins used with meals?

A

Onset 30-60 mins

Peak 2-4 hrs

Last5- 8 hrs

26
Q

What T1DM patient would find advanced carbohydrate counting useful?

A
  • those on multiple daily injections (MDI).

- people on continuous subcutaneous insulin infusion (SCII) pumps

27
Q

What are the components of advanced carbohydrate counting?

A

Insulin to carbohydrate ration (ICR)

Insulin sensitivity factor (ISF)
{also known as correction factor (CF)}

28
Q

Rapid-acting prandial insulin can be adjusted according to food intake. TRUE/FALSE?

A

TRUE

Patients can increase their rapid-acting insulin for consumption of a larger meal

29
Q

How many units of insulin should be administered for each 10g of carbohydrate?

A

1 unit of insulin per 10g

=> a plate of spaghetti with 65g of carbs would require 6.5 units of insulin

30
Q

How do insulin pumps deliver a patients insulin?

A
  • continuous administration of SHORT ACTING insulin subcutaneously
  • Deliver Background insulin dictated by BASAL rate
  • Deliver MANUALLY ACTIVATED bolus of insulin to cover meals (calculated by carb. counting)
31
Q

Can the basal rate of insulin infusion be altered on an insulin pump?

A

Yes

Basal rates can be programmed in advance and may be set to different rates at different times of the day

32
Q

Bolus infusions from the insulin pump can be given in a variety of profiles. What are each of these?

A 
Standard (one short infusion)
Dual (two short infusions)
Multiple (many short infusions)
Short extended (no peak infusion)
Long extended (longer infusion with no peak)
33
Q

Why is continuous glucose monitoring deemed more effective than only measuring prior to meals?

A

Glucose may be within normal ranges at those specific times,
BUT visualising a graph of continuous glucose monitoring could show total instability at other times

34
Q

What does HbA1c actually represent?

A

Glycated Haemoglobin

35
Q

What device is now used for flash glucose monitoring?

A

Freestyle Libre

36
Q

What are the advantages of normal pancreatic insulin secretion?

A
  • directly into portal blood stream
  • rapidly prevents post-meal hyperglycaemia
  • rapidly cleared
37
Q

What are the disadvantages to the insulin preparations that are currently on the market?

A
  • injected into subcutaneous tissue
  • peak too slow to prevent post-meal hyperglycaemic spike
  • slow clearance
  • need to be accurate with injection site
  • leakage must be minimised
38
Q

What must injected sites be checked for?

A

Lipohypertrophy

39
Q

What are the top 3 errors within insulin prescribing that cause most insulin related incidents in the UK?

A
  • WRONG DOSE
  • INSULIN OMISSION
  • WRONG INSULIN TYPE
40
Q

When can IV insulin be used?

A
  • Diabetic Ketoacidosis (DKA)
  • Hyperosmolar Hyperglycaemic State (HHS)
  • Acute illness
  • Fasting patients who are unable to tolerate oral intake
41
Q

How should patients on IV Insulin be monitored?

A

Hourly blood glucose monitoring
(Aim for 5 -12 mmol/L)
Check ketones if BG > 12 mmol/L
Check U & E’s at least daily

42
Q

What treatments are considered non-insulin adjuncts which are suitable for use in T1DM?

A

Metformin
Leptin
GLP-1
SGLT2

43
Q

What are the two types of pancreatic transplant that can be offered in diabetes?

A 
Kidney-Pancreas Autotransplantation
Islet Autotransplantation (islet cells introduced into liver)
44
Q

What type of patients are usually eligible for islet cell transplantation?

A
  • episodes of severe hypoglycaemia
  • Severe and progressive long-term complications despite maximal therapy
  • Uncontrolled diabetes despite maximal treatment
45
Q

What immunosuppression is used for an islet cell transplantation?

A

Mycophenalate

Tacrolimus

ENDOCRINE (22 decks)

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