AD 6th Oct issue | Page 24

6 OCTOBER 2023 ausdoc . com . au remain free of complications have very good health outcomes . Indeed , they may have better health than other adults of the same age because of their health-related behaviours . 27 In contrast , those individuals who develop complications , like kidney or heart disease , often experience poor health and tragically shortened lives . Prevention of complications through optimal early control of glucose levels and other risk factors is therefore the best way to manage type 1 diabetes .

CASE STUDY

JOHN , 26 , is a fit and active real estate agent . He presents to his GP with a three-month history of increasing polyuria , polydipsia , fatigue and 15kg of unintentional weight loss . Following an unremarkable history and clinical examination , a blood test shows a plasma glucose concentration of 16mmol / L ( normal : less than 11.1mol / L ) and an HbA1c of 13 % ( target HbA1c : less than 7.0 %), confirming the presence of diabetes ( see box 2 ).

His GP makes a presumptive diagnosis of type 1 diabetes , and John , who weighs 80kg , is started on a basal – bolus regimen of insulin at a dose of 0.5 units / kg , divided into 16 units of insulin glargine at night and 8 units of insulin aspart with each of his three meals during the day ( a total of 40 units daily ).

Subsequent blood tests are positive for anti-GAD65 and ZnT8 antibodies , confirming the diagnosis of type 1 diabetes .

John is linked in with a credentialled diabetes educator who provides him with ongoing insulin dose titration advice and registers him on the NDSS so that he can access subsidised diabetes medications and supplies . He is also reviewed by a diabetes-accredited dietitian who provides appropriate dietary advice given his busy and active lifestyle . In addition , the GP refers John to a tertiary hospital outpatient diabetes clinic for ongoing follow-up as he is keen to trial CGM to optimise the monitoring of his blood glucose levels , which he often finds difficult during his daytime job .

CONCLUSION

TYPE 1 diabetes is best managed on an individual basis with the continuing support of a diabetes healthcare team . In this team , the GP plays an important role . In making the diagnosis and first breaking the news of a lifelong illness and its potential challenges , the initial conversations with the GP often define the early course of type 1 diabetes .

Type 1 diabetes is a common condition , so every practice should have a co-ordinated action plan ready for each new patient with type 1 diabetes that includes training , therapy , planning and support . If successfully

Box 8 . The risk of hypoglycaemia may be increased in adults with type 1 diabetes after the following

• Excessive physical activity .

• Reduction in dietary carbohydrates or changes in diet composition .

• Excessive alcohol consumption ( inhibits protective glucose production by the liver ).

• Excessive doses or incorrect administration of insulin .

• Changes in insulin formulation / prescription .

• Episodes of hypoglycaemia are more common at night , partly as the adrenergic response is reduced during sleep .

Box 9 . Additional therapy needed

• Optimal control of blood pressure :

— Target a blood pressure of less than 140 / 90mmHg with more intensive control for individuals with or at high risk of cardiovascular or kidney disease .

— Blockade of the renin – angiotensin system ( with ACEIs or ARBs ) is generally preferred because of tolerability and direct effects on endorgan protection .

• Optimal control of serum lipid levels : — Use statins for lipid lowering in adults with type 1 diabetes aged over 40 , in younger individuals with additional CVD risk factors or when the estimated 10-year CVD risk is greater than 10 % using a suitable risk calculator for people with type 1 diabetes . 5

• Mental illness : — Adults with type 1 diabetes have a higher incidence of mental health problems , including depression , anxiety and eating disorders . 5 — Regular screening is appropriate , and early treatment can be helpful , including psychological support and medication as appropriate .

Box 10 . Multidisciplinary diabetes team ndss . com . au

NDSS

NDSS Helpline Helpline 1800 1800 637 637 700 700 ndss ndss . com com . au au

Be aware . Prepare . Survive an emergency .

My Be diabetes aware . Prepare

plan . Survive for natural an emergency

disasters . and emergencies My diabetes plan for natural disasters and emergencies

This plan helps you manage your diabetes Diabetes specific medical supplies in an emergency ( depending on your regular diabetes management )

This plan helps you manage your diabetes Diabetes specific medical supplies

Stress in in an an emergency or a natural disaster can raise or lower

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Planning Empty monitoring sharps container supplies life-threatening ahead reduces situations the . risk of diabetes-related infections and Urine Empty or blood sharps ketone container checking strips life-threatening situations .

This plan also lists important things to put in a diabetes

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perishable cans of foods sweet ( soft For example drink , glucagon peanut kit butter , a supply , crackers of nonperishable replacement foods shakes ( For example or bars peanut ) butter , crackers ,

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Keep this plan and your emergency kit together in a safe meal place and Keep keep this them plan up and to your date emergency . kit together in a safe meal replacement shakes or bars ) place and keep them up to date .

Cotton balls and tissues Cotton balls and tissues

Emergency kit checklist Alcohol swabs

Emergency kit checklist

Alcohol swabs A pen and a notebook to record blood glucose levels

A pen and a notebook to record blood glucose levels

Prepare a portable , waterproof , insulated diabetes emergency Prepare a portable , waterproof , insulated diabetes emergency kit to take with you if you need to leave at short notice . Additional items for those on insulin pump therapy if kit to take with you if you need to leave at short notice . Additional items for those on insulin pump therapy

It should It It contain should contain the following the following

: :

Insulin Insulin pump pump settings settings and and passwords

Important Important documents documents

Insulin Insulin pump pump cannulas ( sites ( sites ) and ) and reservoirs

A list of your list of medical and surgery and history A 14 day 14 supply of of or or - in in of

A list of your medical and surgery history

A 14 day supply of syringes or insulin pens - in case of damage to your to your pump pump

A letter from A letter letter your from from diabetes your your diabetes diabetes healthcare healthcare healthcare provider provider provider on your on on your damage to your pump your diabetes diabetes diabetes medication medication medication regimen regimen regimen

This This plan plan is in is addition in addition to to general emergency

A copy of A copy copy your of of sick your your day sick sick action day day action action plan plan

This plan is in addition to general emergency plan preparedness . Check Check your your state state and and territory fire fire and

A copy of copy this completed of this completed plan plan preparedness . Check your state and territory fire and

A copy of this completed plan emergency services for for additional actions or or items to to emergency services for additional actions or items to Copy of your photo ID consider in the case of an emergency Copy of Copy your of photo your IDphoto ID consider in the in the case case of of an an emergency . .

CHECK THE EXPIRY DATE of your supplies Other important items for your emergency kit CHECK CHECK THE EXPIRY THE EXPIRY DATE of DATE your of supplies your supplies Other Other important items items for for your your emergency kit

UPDATE THIS PLAN at the start of every season . UPDATE UPDATE THIS PLAN THIS at PLAN the start at the of start every of every season season . .

Torch and extra batteries Mobile phone charger Torch Torch and and extra extra batteries batteries Mobile Mobile phone phone charger

Lighter and candles and battery pack Lighter Lighter and and candles candles and and battery battery pack pack

General medical supplies Battery powered radio Protective clothing

General General medical medical supplies supplies

Battery Battery powered powered radio radio Protective

Protective clothing clothing

A 14 day supply of your prescription medication First aid kit

Heavy duty gloves A 14 day supply of your prescription medication

First aid kit Heavy duty gloves

A 14 day Non-prescription supply of your drugs prescription such as medication aspirin , paracetamol , First Whistle aid kit Heavy Protective duty eye gloves wear

Non-prescription antacid Non-prescription , vitamins drugs , drugs such or any such as others as aspirin that aspirin , paracetamol you , paracetamol buy and , use , from Whistle

Protective eye wear

Whistle Spare socks Protective eye shoes wear antacid , over antacid vitamins the , counter vitamins , or any others that you buy and use from , or any others that you buy and use from

Spare socks Protective shoes over the counter Spare socks

Protective shoes over the A counter 3 day supply of bottled water per person

For more information about how to use

A 3 day supply of bottled water per person A 3 day supply cooler of bag bottled with 4 water refreezable per person cool packs or FRIO packs

For more this information plan visit ndss about . com how . auto use

A cooler bag with 4 refreezable cool packs or FRIO packs For more this information plan visit about ndss . com how . au to use

A cooler bag with 4 refreezable cool packs or FRIO packs this plan visit ndss . com . au

Your details Name

ADEA is a National Health Professional Body Agent for the NDSS . ADEA is a National Health

Version Professional 4 August Body Agent 2021 . for First the NDSS published . February 2015 .

NDSSPO002 Address

Version 4 August 2021 . First published February 2015 .

NDSSPO002

Personal contacts Name Relationship Telephone

Image reproduced with permission ADEA

• A credentialled diabetes educator .

• A practice nurse .

• A diabetes-accredited dietitian .

• A counsellor / psychologist / psychiatrist / social worker .

• A podiatrist .

• An accredited exercise physiologist .

• A pharmacist .

• Specialist referral may also be appropriate in some cases , including to an : — Endocrinologist . — Ophthalmologist . — Nephrologist . — Cardiologist .

Find this Find resource this resource at ndss at . ndss com . com . au /. emergencies-and-diabetes au / emergencies-and-diabetes

Figure 7 . Diabetes emergency action plan .