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Type 1 Diabetes
Debbie McCauslandPaediatric Diabetes Specialist Nurses
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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.
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Normal Insulin Response
• Insulin ‘unlocks’ the cell doors
• Glucose enters
cells and is used for energy
• Excess glucose stored
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Type 1 Diabetes
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Symptoms
Left untreated Type 1
Diabetes is fatal.
If any of these symptoms are present check blood sugar immediately
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Treatment
Insulin
Healthy Diet
Exercise
Education
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Insulin Regimes
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Long Acting Insulin
Lantus Levemir Onset 1.5 hours
Maximal effect up to24hours
Onset 1 hourMaximal Effect up to 22
hours
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Twice Daily Insulin
Combination of intermediate acting and rapid acting insulin
• Novomix 30
• Humalog mix 25
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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)
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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
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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
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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
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Diet
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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.
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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
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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
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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
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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
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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
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Annual Screening• Coeliac screen at diagnosis• Yearly diabetes health
checks:• Blood tests – TSH,
Lipids• Urine test
(Microalbuminuria)• BP• Foot checks• Retinal screening
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4 Main Complications
• Cardiovascular disease (Heart disease)
• Retinopathy (Eye disease)
• Neuropathy (Nerve disease)
• Nephropathy (Kidney disease)
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Retinopathy
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Common Foot Problems
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Diabetes And Foot Problems
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Education Programme• Carbohydrate counting• 3months post diagnosis• 1year post• Annual education• Senior school transition• Adolescent clinic• Transition clinic
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Why Do We Want All This?
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Thank You For Listenin
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