Type 1 Treatment (Insulin therapy) Flashcards
what devices are used to deliver insulin
syringe
disposable pen
re-usable cartridge pen
continuous subcutaneous insulin infusion pump
what are the main aims of insulin therapy
prevent hyperglycaemia
avoid hypoglycaemia
reduce chronic complications
how is glucose secreted normally
at a low basal rate accounting for 50% of insulin produces
post-prandial insulin secreted in relation to post meal glucose
what is a BD insulin regimen
rapid acting analogue-intermediate mixture once a day
short acting-intermediate picture once a day
how should most people with T1DM be treated
MDI (x3-4 injections per day) or CSII (continuous subcutaneous insulin infusion)
what insulins are used as pradial insulins (at meal times)
Insulin analogues -aspart (Novorapid) -lispro -glulisine peak 60-90 mins
soluble insulins
-actrapid
-humulin S
peak 2-4 hours
what are the basal isoprene insulins
Insulatard
Humulin I
intermediate/long acting
peak 4-6 hours
what are the analogue basal insulins
Lantus (glargine)
lemur (determir)
what is advanced carbohydrate counting
matching the amount of insulin taken to the amount to carbs consumed
what does an insulin pump administer
continuous administration of short acting subcutaneous insulin
background insulin at a basal rate
manually activated bolus insulin to cover meals
how do diabetics monitor their metabolic control
home blood glucose monitoring
urine testing
glycated haemoglobin (HbA1C)
continuous glucose monitor
whats a limitation of blood glucose monitoring
only provides a ‘snap shot’ of the glucose at any given moment
can see the whole thing with a continuous glucose monitor
what is HbA1c
glycated haemoglobin (largest component)
formed by the non-enzymatic glycation of haemoglobin on exposure to glucose
measures average blood glucose
what is normal HbA1c range
48-58mmol/mol
what factors affect insulin absorption/action
pen accuracy leakage temperature of injection site injection depth exercise
common insulin prescribing mistakes
wrong dose
insulin omission
wrong insulin type
things to take account of when prescribing insulin
patients usual regimen and dose blood glucose monitoring ketone monitoring sepsis/acute illness steroid therapy age lifestyle weight current health status
principles of insulin adjustment
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
when to prescribe IV insulin
DKA
Hyperosmolar hyperglycaemic state
acute illness
fasting patients
how should you monitor IV insulin
hourly blood glucose monitoring (aim for BG 5-12mmol/l) free of hypo check ketones if BG<12 check U&E daily safe transition from IV to SC insulin
some alternative insulin formulations
inhaled insulin
oral insulin
what are some non-insulin adjunct therapies in type 1 diabetes
Metformin
Leptin
GLP-1
SGLT2
types of pancreas transplant
kidney-pancreas autotransplantation
islet autotransplantation
what are the indications for a pancreas transplantation
severe hypoglycaemia/metabolic complications
incapacitating clinical or emotional problems
due to receive a kidney transplant
