Phillipa has recently been diagnosed with IDDM. Please discuss a management plan with her ~ introduction and rapport t ~ age (17yo) and occupation (student) how long have you had diabetes ? ~ how did you present ? ~ did you receive any treatment ? - do you have any other current medical illnesses ? - are you on any medications ? ~ smoke: % pack/day ETOH: alcoholic binges every few weeks or 50 - do you have any allergies ? => aS you might know, you have been diagnosed with diabetes, which is a disorder where there 1s 100 much sugar in the blood. This is due to a ‘mpatsment tn theproduction of jnsulip, which ts secreted by the pancreas, Insulin is responsible for taking glucose from the blood and into the cells. Too much glucose in the blood can cause problems for vou heart and blood vessels, eves. ‘Kidneys, immune system and nervous system. vad can dramatically reduce your life expectancy if itis not adequately treated over a long period therefore we must pruvide insulin to the body te prevent this - no cure, but with team work and co-operation from both of us, lifestyle change not life sentence - you need insulin injections for the rest of your life (unless new treatment becomes available) wf Insulin - without insulin you will very sick over several days and may lead to death. Don't want ta ceare but must highlight the importance => involves giving x4 injections per day of insulin - x1 taken 5Ummn before breakiasU/Junctydinner and x1 before bed (basal) ~ injections can be given in the thigh or abdomen (pinch skin; apply pressure after 30s) = change location of injection site (>3cm clockwise fashion) to maintain good absorption to prevent fat atrophy/hypertrophy A + if you we if, mute inpulin may Le quired (adjusted avcurding to BSL, always a4 injections) + if planning to exercise, less insulin is required A - if you give yourself too much insulin, there is a risk that you will drop sugar levels too low, thus less energy to your body. To counteract this, you should take some Jollies to give you a glucose boost. You chould have asceses to thee lollise at all time dl = suggest experiencing a hypoglycaemic attack to allow future recognition of symptoms ../1 (morning headaches, lethargy, night sweats, weight gain, seizures - lower insulin dose) ~ not enough insulin, may start vomiting, feeling dizzy, difficulty concentrating, enter coma ..../1 ‘Therefore. must take insulin or come to hospital * purchase a gluconmeter from the chemist + used w measure sugar levels =IDDM: measure x4/day (aim for < 6-8 fasting, < 8-11 two hrs post meal) - write levels in book to enable monitor and prosress ~ lear to take control of your insulin levels and administration=> diet = regular meals x3/day. with snacks spaced between them x3/day ~ more fruit and vegetables = more natural CHO/fibre (wholemeal bread. potatoes. cereals) = less fat (esp saturated fats) - less refined CHO (sugars, jam, honey, cakes, pastries, chocolate) wl = referral wo dietician dt => stop smoking (worsen blood vessels = heart attacks, amputation from gangrene toes) ../1 => drink alcohol in moderation only. Avoid binges as they cause big swings in your glucose levels wl - important that you exercise for 30min at least 3 times a week wll - remember, less insulin is required with exercise => referral to diabetic educator wll => referral to ophthalmologist a => referral to podiatrist (adequate foot care) wll => regular bloud wests initially w monitor progress (BSL, HVAIC, urinalysis, micrualb.) —../1 => provide phone no. to support groups wll => any questions ? wll s40 Other insulin regimes x1 short acting before ever meal then x1 long acting in the evening (basal levels) => 4 injections ~ x) short-acting before breakfast and lunch. Intermediate/lone acting before dinner=> 3 injections = x1 (mixture of chort-intermediate acting) 30 min hefore breakfast and dinner =>? injections Short acting => actrapid Intermediate => protaphane Long acting => ultratard Side effects of insulin: - hyogivcaemia (morning headaches, letharev. night sweats, weight gain, seizures) lipohypertrophy ~lipoatrophy allergy Causes of hypoglycaemia in a previously stable diabetic on insulin: - decreased food intake, increased exercise, weight loss + injection errors ~ diahetic renal disease