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The Endocrine System > Treatment of Type 1 Diabetes > Flashcards

Treatment of Type 1 Diabetes Flashcards

1
Q

Why is insulin life-saving in type 1 DM?

A

Prevents Diabetic ketoacidosis (DKA)

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2
Q

What is the long-term goal of insulin treatment?

A

Prevent chronic complications of poor glycaemic control

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3
Q

What do the current guidelines recommend for HbA1c?

A

< 18 years: < 59mmol/mol

>18 years: < 53mmol/mol

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4
Q

What are the current guidelines regarding exercise in T1DM?

A

150 minutes of moderate-intense execise weekly

Spread over 3 days, no more than 2 consecutive days without

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5
Q

A carbohydrate snack should be given before exercise if blood glucose levels are below which point?

A

< 5.6 mmol/l

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6
Q

After diagnosis, when should insulin therapy be started?

A

ASAP

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7
Q

How does insulin administration aim to mimic physiological insulin release?

A

Combining a basal insulin with bolus dosing at mealtimes

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8
Q

Give 3 examples of long acting insulins

A
  1. Glargine
  2. Detemir
  3. Degludec
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9
Q

Which intermediate-acting insulin is often used for basal dosing?

A

NPH

(isophane insulin)

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10
Q

Give 3 examples of rapid acting insulins

A
  1. Lispro
  2. Aspart
  3. Glulisine
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11
Q

What is a frequent cause of nocturnal hypoglycaemia?

A

Dinnertime NPH (or other intermediate-long acting insulin)

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12
Q

Which other coexistant conditions contribute to more unstable diabetes?

A
  1. Coeliac disease
  2. Thyroid disease
  3. Addison’s disease
  4. Psychosocial stress
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13
Q

If there is a concern for noctural hypoglycaemia, what should a patient do?

A

Take a 3am blood glucose test

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14
Q

Why are both alcohol and exercise potentially dangerous in T1DM?

A

They can cause delayed hypoglycaemia

(by up to 24 hours)

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15
Q

In patients with uncontrolled postprandial hyperglycaemia, which adjunctive treatment can be used?

A

Pramlintide

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16
Q

What is pramlintide?

A

Amylin analogue

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17
Q

What is amylin and what is its physiological function?

A

A hormone secreted with insulin normally (not at all in T1DM) which promotes the acute 1st phase of the insulin response by:

  1. Slowing gastric emptying
  2. Promoting satiety
  3. Inhibiting inappropriate glucagon secretion
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18
Q

What is the recommened HbA1c level before conception?

A

< 48 mmol/mol

The target during pregancy is 43 mmol/mol

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19
Q

Why should women be evaluated before pregancy?

A
  1. Poor glycaemic control may damage foetus
  2. Retinopathy, nephropathy, neuropathy and CVD in the mother may worsen in pregnancy if it is present
20
Q

Which condition is more common in pregnant women with diabetes?

A

Pre-eclampsia

21
Q

Women with diabetes are at increased risk of having a baby with which type of defect?

A

Neural tube defects

(spina bifida, anencephaly etc.)

22
Q

Which treatment is given to diabetic women to reduce the liklihood of their baby developing neural tube defects during pregancy?

A

Folic acid

(prior to (0.4mg) and during pregancy (5mg))

23
Q

What is the first line treatment for T1DM in non-pregnant adults?

A

Basal-Bolus Insulin

Basal insulin (glargine, NPH, detemir or degludec)

AND

Bolus insulin (regular, lispro, aspart or glulisine) OR pump

24
Q

What are the potential adjunct therapies for the first line T1DM treatment?

A
  1. Pre-meal insulin correction dose
  2. Amylin analogue (e.g. pramlintide)
25
Q

What is the second line treatment for T1DM?

A

Fixed Insulin Dose

Insulin isophane biphasic

OR

Insulin aspart biphasic

OR

Insulin lispro biphasic

OR

Insulin degludec/insulin aspart

26
Q

When would a fixed-dose insulin regimen be used?

A
  1. Already doing well on a fixed dose
  2. Cannot manage 3-4 daily injections
  3. Has trouble mixing insulin
27
Q

What is the first line treatment for someone who is pregnant and has T1DM?

A

Basal-Bolus Insulin

Basal insulin (NPH or detemir)

AND

Bolus insulin (regular, lispro or aspart)

28
Q

What is the second line treatment for someone who is pregant and has type 1 diabetes?

A

Basal-Bolus Insulin

Basal insulin (glarcine)

AND

Bolus insulin (regular, lispro or aspart) OR pump

29
Q

This is different in different situations

How often should patients have their HbA1c checked?

A
  1. Meeting treatment goal (< 59 mmol/mol (< 18 years) or < 53mmol/mol (> 18 years) - Every 6 months
  2. Therapy is being modified or not meeting goal - Every 3 months
  3. Pregnant - Every month
30
Q

If patients with T1DM also have atherosclerotic CVD, which treatment should they also be on as well as standard insulin and adjunctive treatments?

A

High-intensity statin

31
Q

If patients have T1DM and are aged 40-75, without any atherosclerotic CVD or risk factors, what other treatment should they be on as well as standard insulin and adjunctive treatment?

A

Moderate-intensity statin

32
Q

In all patients who have had type 1 diabetes for 5 years or more, yearly screening must take place for what?

A
  1. Increased urinary albumin secretion
  2. Serum creatinine

(estimated kidney glomerular filtration)

33
Q

What characterises diabetic ketoacidosis?

A
  1. Hyperglycaemia
  2. Metabolic acidosis
34
Q

What are the most common triggers or causes for DKA?

A
  1. Missed insulin
  2. Physiological stress such as infection or MI
35
Q

In insulin deficiency (within a T1DM patient), what happens?

A

Stress hormones (glucagon, cortisol and catecholamines) raise blood sugars by stimulating ketogenesis

36
Q

What follows from stress hormone release in a T1DM patient?

A
  1. Hyperglycaemia
  2. Ketosis
37
Q

Why is DKA associated with dehydration?

A

Hyperglycaemia and ketosis cause osmotic diuresis which leads to dehydration

38
Q

What are the symptoms of diabetic ketoacidosis?

A
  1. Dehydration (dry mouth)
  2. Metabolic acidosis
  3. SOB
  4. Abdominal pain
  5. Nausea
  6. Vomiting
  7. Altered snesorium
39
Q

What does the treatment of DKA involve?

A
  1. Rapid rehydration
  2. Insulin infusion
  3. Correction of electrolyte imbalance and potassium repletion
  4. Treatment with bicarbonate (pH < 6.9 only)
40
Q

What is the main complication of insulin treatment?

A

Hypoglycaemia

41
Q

What is the definition of:

a) glucose alert value
b) significant hypoglycaemia

A

a) < 3.9 mmol/l
b) < 3.0 mmol/l

42
Q

How can hypoglycaemia be treated assuming the patient can take oral treatment?

A

118ml (4 fl/oz) of fruit juice or sweetened fluids

or

Glucose tablets (15-20g CHO)

Blood sugar should be tested and the treatment effect should be apparent in 15 minutes

43
Q

What is the treatment for hypoglycaemia if oral intake is not possible?

A

Injection of glucagon

or

IV dextrose

44
Q

What is dextrose?

A

Form of glucose

(5% in water is used as a treatment for hypoglycaemia)

45
Q

What is given to patients with T1DM, should they ever have a severe hypoglycaemic episode?

A

Glucagon kit

(this is useful when a patient cannot eat or drink)

46
Q

Clinically significant hypoglycaemia is defined as what?

A

< 3mmol/l

The Endocrine System (35 decks)

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