management of diabetes type i

7/31/2019 Management of Diabetes Type i

1/11

MANAGEMENT OF DIABETES

TYPE I:


2/11

Proper therapy involves integration of

i.insulin therapy

ii.dietary management

iii physical exercise & fitness

iv.emotional &social support in order toprevent the onset of acute & chroniccompications.


3/11

PRINCIPLES OF DIABETES MANAGEMENT:

1.elimination of clinical features of uncontrolled

diabetes.

2. prevention of DKA.

3. avoidance of hypoglycemia. 4. maintenance of normal growth & maturation.

5. early detection of associated diseases.

6. prevention of emotional disorders.

7. prevetion of chronic vascular complications ofdiabetes.


4/11

Type of Insulin& Brand NamesOnset Peak

Duration

Role in BloodSugarManagement

Rapid-ActingHumalog orlispro

15-30min. 30-90 min

3-5hours

Rapid-acting insulin

covers insulin needs

for meals eaten at

the same time as

the injection. This

type of insulin is

used with longer-

acting insulin.

Novolog oraspart

10-20min. 40-50 min.

3-5hours

Apidra orglulisine

20-30min. 30-90 min.

1-2hours


5/11

Short-Acting

Regular (R)humulin or novolin

30 min. -1hour 2-5 hours 5-8 hours

Short-acting insulincovers insulinneeds for mealseaten within 30-60

minutesVelosulin (for usein the insulinpump)

30 min.-1hour 2-3 hours 2-3 hours

Intermediate-Acting

NPH (N) 1-2 hours 4-12 hours 18-24hours Intermediate-actinginsulin coversinsulin needs forabout half the dayor overnight. Thistype of insulin isoften combinedwith rapid- orshort-acting insulin.

Lente (L) 1-2 hours 3-10 hours 18-24hours


6/11

Long-Acting

Ultralente (U)30 min.-3 hours 10-20 hours

20-36hours

Long-acting insulin

covers insulin

needs for about

one full day. This

type of insulin isoften combined,

when needed,

with rapid- or

short-acting

insulin.

Lantus 1-1hour

No peak time;

insulin isdelivered at asteady level 20-24hours

Levemir ordetemir

1-2hours 6-8 hours

Up to24hours


7/11

Pre-Mixed*

Humulin 70/30 30 min. 2-4 hours 14-24hours

These products

are generally

taken twice a

day before

mealtime.

Novolin 70/30 30 min. 2-12 hoursUp to24hours

Novolog 70/30 10-20

min.1-4 hours

Up to24hours

Humulin 50/50 30 min. 2-5 hours 18-24hours

Humalog mix75/25 15 min. 30 min.-2 hours 16-20hours

*Premixed insulins are a combination of specific proportions of

intermediate-acting and short-acting insulin in one bottle or

insulin pen (the numbers following the brand name indicate the

percentage of each type of insulin).


8/11

DIABETICKETOACIDOSIS

People with type 1 diabetes do not have enoughinsulin, a hormone the body uses to break downsugar (glucose) in the blood for energy. Whenglucose is not available, fat is broken down instead.

As fats are broken down, acids called ketones buildup in the blood and urine. In high levels, ketonesare poisonous. This condition is known asketoacidosis.

Blood glucose levels rise (usually higher than 300mg/dL) because the liver makes glucose to try tocombat the problem. However the cells cannot pullin that glucose without insulin
http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000305/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003482/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003482/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000305/


9/11

TREATMENT

Insulin replacement

Fluid and electrolyte replacement
http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002350/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002350/


10/11

Comparison of type 1 and 2 diabetes

Feature Type 1 diabetes Type 2 diabetes

Onset&diagnosis Sudden;peak age:11-12yrs;diagnosed before 20 yrsGradual;diagnosed after 40yrs

Age at onsetMostly in Children (days orweeks);insulin levels low or

nonexistent

Mostly in adults.insulinlevels may be normal,mild

elevated or depressed

EtiologyCirculating islet cellantibodies presentunknown,butgenetic,viralor autoimmunefactors

No Circulating islet cell

antibodiesUnknown,but genetic &envt.factors areimportant.;riskfactos:obesity


11/11

Management

Dependent on insulin toprevent ketoacidosis &sustain life

Insulin,diet(mealplanning) &exercise

Not Dependent on insulinto sustain life & notprone for ketoacidosis

Insulin may requiredtemporarily for Periods ofstress like:

surgery,trauma,orinfection

diet(mealplanning)&exercise,occassionaly oralhypoglycemicagents&/insulin

Body habitus Thin or normal Often obese

Ketoacidosis Common Rare

Autoantibodies Usually present Absent

Endogenous insulin Low or absent Normal, decreasedor increased

Concordancein identical twins 50% 90%

Prevalence ~10-20% ~80-90%

PreventionNone known,but futureresearch may clarifyetiology

Even small weight lossesmay return plasmaglucoseto normal in many

pts with this type
http://en.wikipedia.org/wiki/Diabetic_ketoacidosishttp://en.wikipedia.org/wiki/Autoantibodieshttp://en.wikipedia.org/wiki/Autoantibodieshttp://en.wikipedia.org/wiki/Identical_twinhttp://en.wikipedia.org/wiki/Identical_twinhttp://en.wikipedia.org/wiki/Identical_twinhttp://en.wikipedia.org/wiki/Concordance_(genetics)http://en.wikipedia.org/wiki/Autoantibodieshttp://en.wikipedia.org/wiki/Diabetic_ketoacidosishttp://en.wikipedia.org/wiki/Obese

management of diabetes type i

Documents