Type one diabetes (R1): ongoing management

Question 1

Principles of ongoing management for T1DM?

Answer 1

Glycaemic control
- Monitoring
- Insulin therapy
- Lifestyle

Sick day management
Monitoring complications

Question 2

Monitoring
- 2 ways we can monitor glycaemic control?

Answer 2

BGLs and Hb1Ac

Question 3

Monitoring
- 2 ways we can monitor BGLs?

Answer 3

• Capillary BGL tests (finger pricks)
• Continuous glucose monitoring (not as accurate, but can identify trends and alert patient to high/low BGLs)

Question 4

Monitoring: HbA1c
- What does it show?
- What should we aim for in
a) in general?
b) young/early diagnosis/few complications?
c) severe hypoglycaemia

Answer 4

Average BGLs over the past ~3months

a) 7%
b) 6-7%
c) 7.5-8%

Question 5

Insulin therapy
- 2 approaches?

Answer 5

Multiple daily injections
Insulin pump

Question 6

Insulin therapy: multiple daily injections
- There are 2 categories of insulin given, what are they and what are their purpose?

Answer 6

Basal insulin: given so there is a baseline level of insulin
Bolus insulin: given at meals

Question 7

Insulin therapy: pumps
- Does it deliver basal insulin + bolus for meals?
- Do you need to put in BGLs/count carbs to determine insulin dose?
- Can BGL sensors be integrated into the pump?

Answer 7

Yes
Yes
Yes

Question 8

Pharmacology: insulin
- What are the different types of insulin (based on time profiles?

Answer 8

Question 9

Pharmacology: insulin
- 3 types of rapid acting insulin?

Answer 9

Insulin aspart (Novorapid)
Insulin lispro (Humalog)
Insulin glulisine (Apidra)

Question 10

Pharmacology: insulin
- 3 types of long acting insulin?

Answer 10

Insulin detemir (Levemir)
Insulin glargine 100units/mL (Optisulin)
Insulin glargine 300 units/mL (Toujeo)

Question 11

Pharmacology: insulin
- What devices are available?
- What ADRs are there?

Answer 11

Syringes, pens, InnoLet, pumps
Hypoglycaemia, weight gain (anabolic function), lipodystrophy

Question 12

Lifestyle
- Recommendations?

Answer 12

Diet: dietician; carb counting and adjusting insulin dose
Exercise: regular physical activity, however monitor BGLs
Quit smoking

Question 13

Sick day management
- Why is it important?
- Recommendations?

Answer 13

Important as illness can lead to BGL disturbances (usually hyperglycaemia due to release of stress hormones)

Monitor BGLs and ketones, manage accordingly
Try to keep eating and drinking as normal

Question 14

Screening for complications?

Answer 14

Question 15

Explaining to patients

Answer 15