Type 1 diabetes: insulin therapy, technology and ambulatory care

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Target exams

Red flags

• Insulin must never be stopped during an intercurrent illness — the dose is adjusted up for fever and hyperglycaemia, and stopping it is the fastest route to diabetic ketoacidosis
• A child with vomiting and blood ketones above 1.5 millimoles per litre on sick-day management is heading for ketoacidosis and needs escalation, not more fluids at home
• Recurrent severe hypoglycaemia in a child on a pump usually means a blocked cannula or site failure rather than overtreatment — check the infusion set before adjusting the algorithm
• Disordered eating and insulin omission for weight control are common in adolescent girls and present as unexpectedly high HbA1c with frequent ketones — screen actively and non-judgementally
• A pump user can develop ketoacidosis within hours of a cannula failure because there is no long-acting basal depot — always check ketones in any unwell pump-treated child
• Loss of hypoglycaemia awareness predicts the next severe episode — tighten targets only after awareness is restored, and consider technology that predicts lows

Life stages

Care settings

Clinical exam formats

Board mappings

• Insulin therapy and diabetes technology in type 1 diabetes
• Insulin therapy, pump and closed-loop management
• Insulin regimens, continuous glucose monitoring and closed-loop systems
• Long case: ambulatory type 1 diabetes and technology
• Diabetes mellitus: ongoing management and technology
• Insulin therapy and diabetes technology
• Diabetes: ambulatory and sick-day management
• Type 1 diabetes mellitus: management and technology
• Patient Care: insulin therapy, technology and ambulatory diabetes care
• Medical Expert: type 1 diabetes ambulatory management