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Type 1 Diabetes - Coggle Diagram

- - - - PATIENT TEACHING OF INSULIN:
        -Medication controls hyperglycemia but does not cure diabetes, therapy is long-term.
        -Review signs of hypo/hyperglycemia with patient and if occurs explain what patient should do
        -Explain proper administration and how to use the equipment and proper storage and syringe disposal
        -Alternate injection sites
      - Monitoring glycemic control: Glycated hemoglobin (A1C)- A1C is monitored typically every three months as an index of long-term glycemic control. Blood glucose is frequently monitored several times daily by fingerstick or a device for continuous monitoring. This data is used to adjust insulin dosing.
      - Targets for glycemic control:: A target A1C OF <7 PERCENT (53 MMOL/MOL) is recommended for most children, adolescents and adults. Targets for blood glucose are approximately 80 to 130mg/dL (4.4 to 7.2 mmol/l) before meals and 80 to 140 mg/dL (4.4 to 7.8 mmol/L) at bedtime and overnight.
      - Insulin regimen: Design a regimen to maintain blood glucose in a target range and anticipating the effects of meals, exercise, and fasting on glycemic excursions. Varies extremely based of age and is important to always do age-based care.
      - Insulin regimens: Basic requirements of an optimal insulin regimen include administration of a basal insulin plus mealtime boluses of a rapid- acting insulin or short-acting insulin. Basal insulin can be delivered by daily or twice-daily injections of an intermediate- acting (NPH or detemir) or long-acting insulin preparation or continuous subcutaneous insulin infusion (CSII) via a pump using a rapid-acting insulin preparation.
      - Dose adjustments and absorption: An advantage of CSII is allowing flexibility of insulin dosing and adjustments by a basal rate being programed and it can time meals. Doses as low as 0.05 units can be delivered with CSII where non-pump insulin delivery can only provide insulin at 0.5 to 1 unit increments.
      - Choosing basal/prandial insulin: This choice of basal ad prandial insulin for an MDI regimen depends upon patient preference, lifestyle and costs concerns.
      - Basal insulin options:
        Insulin glargine- given before breakfast, before dinner, or at bedtime. Some patients with type 1 achieve better glycemic control with glargine given twice per day.
        Insulin detemir- Duration is shorter than glargine but longer than NHP. Twice- daily injections appear to be necessary and duration of action is shorter when lower doses are used.
      - Prandial insulin options: Prandial boluses are necessary and either rapid-acting insulin or short- acting (regular) can be given pre-meal. Rapid-acting insulins can be injected 10 to 15 minutes before or up to immediately after meals, whereas regular insulin should be given 30 to 45 minutes or more before meals.
      - Follow- up: Frequency is key to adjust insulin regimens and should be seen around every three months. Also it is important to assess glucose patterns and insulin adjustments. At these follow-ups many patterns and problems can be identified like postprandial hyperglycemia, fasting hyperglycemia and no discernible pattern.