Type 1 Diabetes Debbie McCausland Paediatric 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 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 hour Maximal 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

11 Insulin Pump Therapy Continuous Subcutaneous Insulin Infusion (CSII)

How Does an Insulin Pump Work? Components and their functions: A small computerised, battery operated pump o Allows precise control of insulin delivery A pump reservoir o Holds 2 to 3 days worth of insulin A thin plastic tube called an infusion set o 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 Counting AdvantagesDisadvantages 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

Hypoglycaemia Autonomic BGL<3.5mmols Neuroglycopenia BGL<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 Listening