Type 1 Diabetes Management Flashcards by raniya robb

When was Insulin first isolated and by who?

1922

Banting & Macleod

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

1990s

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When were basal analogue insulins first introduced?

2000s

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What devices are available to administer insulin?

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

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What symptoms commonly indicate hyperglycaemia?

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

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How does hyperglycaemia affect cognitive function?

affects mood state
compromises information processing
impaired working memory

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What serious condition is a hyperglycaemic patient at risk of?

Diabetic ketoacidosis (DKA)

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List the main symptoms of hypoglycaemia

Pallor
sweating
tremor
palpitations
confusion
nausea
hunger

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How can hypoglycaemia affect cognitive function?

Tense-tiredness
Compromised information processing
Impaired working memory
Coma

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What percentage of insulin released is basal?

50%

=> the other 50% = post prandial

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

Rapid-acting analogue

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Give examples of short-acting insulin

Humulin S (Human insulin)
Actrapid
Insuman Rapid

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Give examples of intermediate acting insulin

Insulatard
Humulin I (human insulin)
Insuman Basal

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Give examples of Long acting insulin preparations

Lantus

Levemir

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

Rapid-acting analogue/Intermediate Mixture

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

Short-acting/Intermediate Mixture

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What insulin regimen aims to mimic normal endogenous insulin production?

Basal bolus insulin regimen

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

to reduce hypoglycaemia risk

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

Start at 0.3 units/kg body weight

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

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

Rougly 4-7mmol/l

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

<10mmol

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

TRUE

at least 50-80% require this

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

Rapid-acting analogues
Short acting (soluble human insulin)

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

Onset of action 10-15 mins

Peak action 60-90 mins

Duration 4-5 hrs

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

Onset 30-60 mins Peak 2-4 hrs Last5- 8 hrs

What T1DM patient would find advanced carbohydrate counting useful?

- those on multiple daily injections (MDI). | - people on continuous subcutaneous insulin infusion (SCII) pumps

What are the components of advanced carbohydrate counting?

Insulin to carbohydrate ration (ICR) Insulin sensitivity factor (ISF) {also known as correction factor (CF)}

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

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

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

1 unit of insulin per 10g => a plate of spaghetti with 65g of carbs would require 6.5 units of insulin

How do insulin pumps deliver a patients insulin?

- 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)

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

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

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

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

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

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

What does HbA1c actually represent?

Glycated Haemoglobin

What device is now used for flash glucose monitoring?

Freestyle Libre

What are the advantages of normal pancreatic insulin secretion?

- directly into portal blood stream - rapidly prevents post-meal hyperglycaemia - rapidly cleared

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

- 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

What must injected sites be checked for?

Lipohypertrophy

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

- WRONG DOSE - INSULIN OMISSION - WRONG INSULIN TYPE

When can IV insulin be used?

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

How should patients on IV Insulin be monitored?

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

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

Metformin Leptin GLP-1 SGLT2

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

``` Kidney-Pancreas Autotransplantation Islet Autotransplantation (islet cells introduced into liver) ```

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

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

What immunosuppression is used for an islet cell transplantation?

Mycophenalate | Tacrolimus