Diabetes Mellitus Type I DMI: Department of Family Medicine and General Practice Rcsi
Diabetes Mellitus Type I DMI: Department of Family Medicine and General Practice Rcsi
Diabetes Mellitus Type I DMI: Department of Family Medicine and General Practice Rcsi
DM I
Injection technique
Site of injection
Sick day rules
Complications from
injecting insulin
Insulin regimens
Multiple injection or
basal bolus therapy
Twice daily therapy
Three times daily
therapy
Insulin glargine and
insulin detemir
Continuous
subcutaneous insulin
infusion therapy
Intensive control of
hyperglycaemia
Benefits
Side effects
Evidence
Goals
Monitoring
Regimens
When to refer?
Emergency referral
Acute-onset symptoms
suggestive of DM I
Children with DM
should be referred on
the same day as
diagnosis
Blood glucose >
25mmol/l and ketones
in urine
When to refer contd.?
Routine referral
Uncontrolled hyperglycaemia
Uncontrolled hypertension
Persistent proteinuria
Creatinine level >150mol/l
Retinopathy or visual impairment
Painful neuropathy/
mononeuropathy/ amyotrophy
At risk feet (foot ulcers urgent
referral)
Pyschological problems related to
diagnosis
Continuing care
Eyes
Feet
Kidneys/microalbuminuria
Screening for complications
is thus important
Complications
When to refer?
Eyes opthalmologist
annually
Feet 6 monthly by
podiatrist
Foot ulcers urgent referral
Ischaemic DM foot vascular surgeon
Diabetic renal disease nephrologist once
serum creatinine >
150mol/l
How to treat complications
Eye problems - medical ACE inhibitors
- surgical laser
Foot ulcers - medical IV abs/rest
- surgical debridement
Microalbuminuria- medical glycaemic
control
BP
ACE inhibitors
Final aims in DM I
Aim for
Haemoglobin A1c < 7.0%
Blood Pressure < 130/80 mm Hg
Fasting plasma glucose <4.46.1mmol/l
Total cholesterol < 4.0 mmol/l
Low-density lipoprotein < 2.0 mmol/l
Fasting triglycerides <1.7 mmol/l
Formative assessment