Type 1 diabetes mellitus: management
The initial care and subsequent
long-term management of patients with T1DM should be delivered by a specialist
paediatric diabetes team. All newly diagnosed patients must start insulin
therapy as soon as possible. An intensive programme of education and support is
needed for the child and parents. The aims of management of T1DM are:
· education of child and family
about diabetes;
· insulin therapy;
· nutritional management;
·
monitoring
of glycaemic control;
·
avoidance
and management of hypoglycaemia;
·
management
of acute illness and avoidance of DKA;
·
screening
for development of associated illness;
·
screening
for diabetes-related microvascular complications;
·
prevention
and treatment of microvascular complications.
An intensive programme of
education and counselling is needed in the first few days/weeks to cover the
fundamental principles about T1DM and its management.
· Basic pathophyisology of T1DM.
· Insulin
therapy:
· actions of insulin;
· SC injection techniques;
· dose adjustment principles,
including carbohydrate counting techniques.
· Home/self blood glucose
monitoring.
· Acute
complications:
· avoidance, symptom recognition,
and treatment of hypoglycaemia and diabetic ketoacidosis.
· ‘sick day rules’ during illness to
prevent DKA.
· Diet:
· healthy, low-fat;
· high complex carbohydrate.
· Long-term
complications: risk
factors and avoidance.
· Psychological issues.
A considerable amount of time and
need for repetition is required to deliver this information. The process of
education and support is a con-tinual one with a need for regular review and
updates of knowledge.
Diet and insulin regimen need to
be matched to optimize glycaemic con-trol. Instruction on and application of
carbohydrate counting techniques are required. A healthy diet is recommended
with a high complex carbo-hydrate and relatively low fat content.
· 50–60% carbohydrate (complex/high
fibre)
· <30% fat (<10% in form of
saturated fat)
· 15–20% protein
· Refined sugars limited to
<25g/day
·Regular daily blood glucose
monitoring and testing when blood levels are suspected to be low or high is
recommended.
·Home blood glucose monitoring is
normally carried out using a portable glucose meter and finger-pricking device.
·Regular testing is required to
assist with insulin dose-adjustment decisions, and to learn and predict how
changes in lifestyle, food, and exercise affect glycaemic control.
·A minimal testing frequency of 4
times per day should be encouraged.
·SC continuous glucose monitoring
(CGM) devices are also now available and in certain select situations may offer
some advantages and benefits to patients.
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