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 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
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
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
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
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