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Type 1 Diabetes
Debbie McCauslandPaediatric Diabetes Specialist Nurses
How many people have diabetes?
• Increase in those with Diabetes has risen from 1.4million to 2.9million since 1996
• Predicted to have 5million people with diabetes by 2025.
• Majority of these have Type 2 diabetes• 10% of all adults will develop type 1
diabetes by age of 40yrs• Type 1 diabetes is the most common type
of diabetes in children.
Normal Insulin Response
• Insulin ‘unlocks’ the cell doors
• Glucose enters
cells and is used for energy
• Excess glucose stored
Type 1 Diabetes
Symptoms
Left untreated Type 1
Diabetes is fatal.
If any of these symptoms are present check blood sugar immediately
Treatment
Insulin
Healthy Diet
Exercise
Education
Insulin Regimes
Long Acting Insulin
Lantus Levemir Onset 1.5 hours
Maximal effect up to24hours
Onset 1 hourMaximal Effect up to 22
hours
Twice Daily Insulin
Combination of intermediate acting and rapid acting insulin
• Novomix 30
• Humalog mix 25
Basal Bolus
Basal = background insulin• Lantus• Levemir
Bolus = give with food or to correct BGL• Novorapid• Humalog• Apidra
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Insulin Pump Therapy
Continuous Subcutaneous Insulin
Infusion (CSII)
How Does an Insulin Pump Work?
Components and their functions:• A small computerised, battery operated
pumpo Allows precise control of insulin delivery
• A pump reservoiro Holds 2 to 3 days worth of insulin
• A thin plastic tube called an infusion seto Has a soft cannula or needle at the end inserted
just under the skin
How does it work?• Insulin passes into the subcutaneous (fat)
tissue
Continuous Subcutaneous Insulin Infusion (CSII)
• Programmed delivery of a constant background rate of insulin (basal rate)
• Programmable to match the individual’s needs
• Boluses of insulin given with food to the match the carbs eaten
14
Insulin Infusion
Insulin
Cannula
Subcutaneous Tissue
Skin
Important Factors When Giving Insulin
• Who gives the injection?• Timing in relation to food• Injection technique• Preparation of pen• Needle length• To pinch or not to pinch?• Injection sites• Storage of insulin• Expiry of insulin
Diet
Carbohydrate Counting
• A method for controlling blood glucose levels by accurately matching the amount of carbohydrate that is eaten and drunk to the amount of insulin taken.
CHO CountingAdvantages Disadvantages
• Helps to improve overall diabetic control
• No need to snack to avoid hypos
• More flexibility with meal times
• More flexibility with portion sizes
• More flexibility with foods eaten
• Stabilise blood glucose levels with less fluctuations and swings
• Takes more time and effort
• Requires more blood testing and record keeping
• Requires maths!!• Not always easy to
estimate carbohydrate content of foods when eating out – at school or in restaurants
Exercise
• Regular exercise enables the young person to utilize the glucose in their body.
• Helps weight control• Improves self motivation• Helps maintain good glycaemic
control
HypoglycaemiaAutonomic
BGL<3.5mmolsNeuroglycopeniaBGL<2.5mmols
• Shaking hands/legs• Pallor• Sweating• Nausea/hunger• Palpitations
• Drowsiness & tiredness
• Headaches/blurred vision
• Speech difficulties• Poor coordination• Changes in behaviour,
mood & judgment• Confusion/convulsion
Hyperglycaemia• A blood glucose level above 8mmol/l• Correction of blood glucose by s/c insulin• Test BGL every 2 hour• Test BKL if BGL > 14mmol/l• If BGL >20mmol/l exercise can increase BGL
further – need to correct with insulin first.• No improvement after 2 correction bolus may
need medical review
Diabetic Ketoacidosis• Caused by lack of insulin• Elevated blood glucose and blood ketones• Vomiting, polyuria, polydipsia, weight loss,
tiredness• Changes in blood gas:
• pH < 7.3• BE < 15
• Dehydrated• Deep sighing respiration (Kussmaul breathing)• Drowsiness, lethargic, confused• Smell of ketones
Annual Screening• Coeliac screen at diagnosis• Yearly diabetes health
checks:• Blood tests – TSH,
Lipids• Urine test
(Microalbuminuria)• BP• Foot checks• Retinal screening
4 Main Complications
• Cardiovascular disease (Heart disease)
• Retinopathy (Eye disease)
• Neuropathy (Nerve disease)
• Nephropathy (Kidney disease)
Retinopathy
Common Foot Problems
Diabetes And Foot Problems
Education Programme• Carbohydrate counting• 3months post diagnosis• 1year post• Annual education• Senior school transition• Adolescent clinic• Transition clinic
Why Do We Want All This?
Thank You For Listenin
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