Type 1 Treatment (Insulin therapy)

Question 1

what devices are used to deliver insulin

Answer 1

syringe
disposable pen
re-usable cartridge pen
continuous subcutaneous insulin infusion pump

Question 2

what are the main aims of insulin therapy

Answer 2

prevent hyperglycaemia
avoid hypoglycaemia
reduce chronic complications

Question 3

how is glucose secreted normally

Answer 3

at a low basal rate accounting for 50% of insulin produces

post-prandial insulin secreted in relation to post meal glucose

Question 4

what is a BD insulin regimen

Answer 4

rapid acting analogue-intermediate mixture once a day

short acting-intermediate picture once a day

Question 5

how should most people with T1DM be treated

Answer 5

MDI (x3-4 injections per day) 
or CSII (continuous subcutaneous insulin infusion)

Question 6

what insulins are used as pradial insulins (at meal times)

Answer 6

Insulin analogues 
-aspart (Novorapid) 
-lispro
-glulisine 
peak 60-90 mins 

soluble insulins
-actrapid
-humulin S
peak 2-4 hours

Question 7

what are the basal isoprene insulins

Answer 7

Insulatard
Humulin I

intermediate/long acting
peak 4-6 hours

Question 8

what are the analogue basal insulins

Answer 8

Lantus (glargine)

lemur (determir)

Question 9

what is advanced carbohydrate counting

Answer 9

matching the amount of insulin taken to the amount to carbs consumed

Question 10

what does an insulin pump administer

Answer 10

continuous administration of short acting subcutaneous insulin

background insulin at a basal rate

manually activated bolus insulin to cover meals

Question 11

how do diabetics monitor their metabolic control

Answer 11

home blood glucose monitoring
urine testing
glycated haemoglobin (HbA1C)
continuous glucose monitor

Question 12

whats a limitation of blood glucose monitoring

Answer 12

only provides a ‘snap shot’ of the glucose at any given moment

can see the whole thing with a continuous glucose monitor

Question 13

what is HbA1c

Answer 13

glycated haemoglobin (largest component)

formed by the non-enzymatic glycation of haemoglobin on exposure to glucose

measures average blood glucose

Question 14

what is normal HbA1c range

Answer 14

48-58mmol/mol

Question 15

what factors affect insulin absorption/action

Answer 15

pen accuracy 
leakage 
temperature of injection site 
injection depth 
exercise

Question 16

common insulin prescribing mistakes

Answer 16

wrong dose
insulin omission
wrong insulin type

Question 17

things to take account of when prescribing insulin

Answer 17

patients usual regimen and dose 
blood glucose monitoring 
ketone monitoring 
sepsis/acute illness 
steroid therapy 
age
lifestyle 
weight 
current health status

Question 18

principles of insulin adjustment

Answer 18

review glycemic control
adjust routine insulin proactively to optimise glycemic control
adjust insulin prior to problem
do not omit insulin iff hypo, treat hypo and administer insulin as usual

Question 19

when to prescribe IV insulin

Answer 19

DKA
Hyperosmolar hyperglycaemic state
acute illness
fasting patients

Question 20

how should you monitor IV insulin

Answer 20

hourly blood glucose monitoring (aim for BG 5-12mmol/l) 
free of hypo 
check ketones if BG<12 
check U&amp;E daily 
safe transition from IV to SC insulin

Question 21

some alternative insulin formulations

Answer 21

inhaled insulin

oral insulin

Question 22

what are some non-insulin adjunct therapies in type 1 diabetes

Answer 22

Metformin
Leptin
GLP-1
SGLT2

Question 23

types of pancreas transplant

Answer 23

kidney-pancreas autotransplantation

islet autotransplantation

Question 24

what are the indications for a pancreas transplantation

Answer 24

severe hypoglycaemia/metabolic complications
incapacitating clinical or emotional problems
due to receive a kidney transplant

Question 25

what happens in an islet transplantation

Answer 25

only the endocrine component of the pancreas is replaced with the aim of restoring physiological glucose homeostasis in people with T1DM

Question 26

4 steps of an islet transplantation

Answer 26

1. pancreas donation and retrieval
2. islet isolation
3. islet culture
4. islet transplantation

Question 27

what are the potential positive outcomes from an islet transplantation

Answer 27

insulin independence
reduction in severe hypoglycaemia
improved glycemic control

Question 28

limitations of islet transplantation

Answer 28

restricted numbers of available donors

need for immunosuppression

Question 29

how are therapies trying to replace B cells in T1DM

Answer 29

making B cell like cells which are mono-hormonal insulin secreting cells

protected mice from diabetes after transplantation