type 1 diabetes debbie mccausland paediatric diabetes specialist nurses

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

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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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