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gwen - diabetes > Type 1 Diabetes - Management > Flashcards

Type 1 Diabetes - Management Flashcards

1
Q

What is the mainstay of management of type I diabetes?

A

Insulin therapy - always indicated in a patient who has been in ketoacidosis, and is usually indicated in lean patients who present under the age of 40 years.

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2
Q

What are the main types of insulin regimens used in those with type I diabetes?

A
  • Basal Bolus
  • Twice Daily mix
  • Three times daily
  • Subcutaneous continuous insulin infusion
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3
Q

What is the premise behind the basal bolus regimen?

A
  • Rapid (or short) acting insulin to cover CHO at meals
  • Basal long acting insulin as background
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4
Q

What insulins are used in a basal bolus regimen?

A

Long-acting insulin

  • Levemir
  • Lantus

Rapid acting insulin

  • Novorapid
  • Humalog
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5
Q

What is a Twice daily mix therapy?

A
  • Rapid acting mixed with intermediate acting insulin
  • Before breakfast (BB) and evening meal (BT)
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6
Q

What insulins are used in the twice daily mix regimen?

A
  • Novomix 30
  • Humalog Mix 25
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7
Q

How is insulin administered?

A

Subcutaneous injection

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8
Q

Why is it difficult to establish insulin response similar to normal physiological response in someone with diabetes?

A
  • Insulin is secreted directly into the portal circulation and reaches the liver in high concentration in normality - Insulin-treated patients therefore have lower portal levels of insulin and higher systemic levels relative to the physiological situation.
  • Subcut insulin takes 60–90 min to achieve peak plasma levels
  • The absorption of subcut insulin into the circulation is variable
  • Insulin invariably peaks and declines in people with diabetes
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9
Q

What is important to educate a patient about when starting them on insulin?

A
  • Bloog glucose monitoring
  • Injection technique and complications
  • Guidance on adjusting dosages
  • DKA
  • Hypoglycaemia Awareness
  • Carb counting
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10
Q

What is important to educate the patient on regarding injection site?

A
  • Rotate injection sites regularly
  • Be aware of lipohypertrophy
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11
Q

What is three times daily mix regimen for treating diabetes?

A

Mix of short and intermediate acting before breakfast, short acting before tea and intermediate acting at bedtime

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12
Q

What are the benefits of basal bolus regimen?

A
  • Suitable for a flexible lifestyle
  • Better for shift workers
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13
Q

What are the benefits of a twice daily mix regimen for treating diabetes?

A
  • Works best if lifestyle is fixed with regular meals
  • Minimises insulin injections
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14
Q

What are the benefits of continuous insulin pumps?

A

Particularly useful in the overnight period, since the basal overnight infusion rate can be programmed to fit each patient’s needs.

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15
Q

When would you consider givign someone an insulin infusion pump?

A
  • Disabling hypoglycaemia
  • Failure to meet HbA1c target
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16
Q

What are the risks of using a insulin infusion pump?

A
  • Skin infections
  • DKA - if pump is blocked
  • Obsessive glucose control
17
Q

What are the main sick day rules with regards to insulin therapy?

A
  • Avoid stopping insulin during acute illness - often increases insulin requirements despite reduced food intake
  • Check BG >/= 4 times daily - if glucose increasing, increase insulin
  • Check for ketones - admit if vomiting, dehydration, ketotic, a child or pregnant

S - Sugar (check blood sugar)

I - Insulin (always take your insulin)
C - Carbs (make sure you’re eating enough)
K - Check for ketones every 4 hours

18
Q

What issue can long acting insulins help deal with?

A

Nocturnal hypoglycaemia

19
Q

What is the following?

A

Lipohypertrophy

21
Q

What are examples of long-acting insulins?

A
  • Levemir
  • Lantus
22
Q

What are examples of Intermediate acting insulins?

A
  • Insulatard
  • Humulin I
  • Novomix - Biphasic
  • Humalog Mix - Biphasic
23
Q

What are examples of rapid-acting insulins?

A
  • Novorapid
  • Humalog
  • Apidra
24
Q

What are examples of short-acting insulins?

A
  • Actrapid
  • Humulin S
25
Q

When should rapid acting insulins be taken?

A

Immediately before, with or directly after a meal

26
Q

When should short-acting insulins be taken in relation to meals?

A

15 mins before meal

27
Q

How long after administration do rapid acting insulins take to have an effect?

A

15 minutes

28
Q

What is the duration of action of rapid acting insulins?

A

4-5hrs

29
Q

What is the duration of action of short-acting insulins?

A

6-8hrs

30
Q

What is the duration of action of intermediate-acting insulins?

A

15-24 hrs

31
Q

What is the duration of action of long acting insulins?

A

18-24 hrs

32
Q

What are complications of insulin therapy?

A
  1. Lipohypertrophy
  2. Allergic response
  3. Insulin resistance
  4. Weight gain
  5. Hypoglycaemia
33
Q

What things need to be checked on a yealry basis in someone with diabetes?

A
  • Biochemical assessment of metabolic control - HbA1c
  • Bodyweight
  • BP
  • Plasma lipids
  • Measure visual acuity/state of retina
  • Test urine for proteinuria/microalbuminuria, Test blood for renal function
  • Foot check
  • Review cardiovascular risk factors
  • Review self-monitoring and injection techniques
  • Review eating habits
34
Q

What is the correct insulin injeciton technique?

A
35
Q

Where should insulin be kept for use?

A

Fridge, although go as per manufacturer’s instructions

36
Q

What are good sites for insulin injection?

A

Abdomen, thigh, arm, buttocks.

Site rotation is important.

Rotate on a weekly basis

37
Q

What should you do with cloudly insulin?

A

Resuspend by rolling 10 times and inverting 10 times

38
Q

How long are injection needles?

A

4-5mm

gwen - diabetes (11 decks)

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