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Clinical > 1 Diabetes L1 > Flashcards

1 Diabetes L1 Flashcards

1
Q

What causes T1 diabetes?

A

Autoimmune destruction of pancreatic B-cells.

Idiopathic - theories about viruses/animal products

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2
Q

Aetiology of T1

A 
Could be either. Reduced insulin secretion
or 
hyperinsulinemia and insulin resistance
or
reduction in insulin recptors
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3
Q

Stages of T2

A

1 hyperinsulineaemia - body compensates for insulin resistance by increasing insulin secretion
2 hyperglycemia - as resistance increases and b-cells fail to compensate glucose levels rise
3 T2 escalating b-cell failure and loss of hypoglycemic control

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4
Q

90% of diabetes is T1/T2?

A

T2

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5
Q

Ethnicities more affected by T1?

T2?

A

T1 - European

T2 - Asian and afriacan-caribean

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6
Q

Difference between DKA and HHS?

A 
Diabetic ketoascidosis (T1)
Hyperosmolar hyperglycaemic state (T2) is like DKA withour the ketones
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7
Q

Diagnostic:
HbA1c for diagnosis
Fasting
2hr post glucose load

A 
>/= 48mmol/mol
>/= 7mmol/L
>/= 11mmol/L
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8
Q

What are the units for
HbA1c?
Blood gluc

A

mmol/mol

mmol/L

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9
Q

Problems with treating diabetes?

A

Diabetes and complications are often silent - treatment may cause more symptom than disease.

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10
Q

How often is diabetes reviewed?

What is screened? (4)

A 
Annually 
Retinal
Nephropathy
Hypertension
Clinical examination for vascular disease
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11
Q

Problem with repeated hypos?

A

Your body stops warning you so eventually there is only a few minutes from being fine to being unconcious

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12
Q

Aim of insulin therapy

A

to replicate what happens in people without diabetes

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13
Q 
Recommended targets
Fasting
2 hour post meal
HbA1c
Urine
A

Fasting 4-7mmol/L
2 hour post meal <8.5mmol/L
HbA1c 48-58mmol/mol
Urine: negative

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14
Q

Indications for insulin use:

A

Type 1
Poor controlled type 2
Intercurrent illness (pre/post op, infection, MI, steroid therapy)
Pregnancy (if uncontrolled)

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15
Q

Once daily basal insulin - advantage of modern basal insulins (lantus and levimir)?

A

less risk of hypo in the night as levels are stable - 24h cover

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16
Q

Insulin degludec advantage/disadvantage

A

Expensive
vs
od ultra long acting and flat profile (reduced risk of nocturnal hypo)

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17
Q

How does insulin degludec work?

A

Forms soluble hexamers at injection site - monomers gradually separate and absorb

18
Q

Isophane insulin is ……. acting

A

Intermediate acing

19
Q

Basal bolus involves how many injections daily?

A

4

1 long acting, 3 rapid

20
Q

Isophane insuline disadvantage compared to long acting insulins?

A

risk of nocturnal hypos

21
Q

BASAL BOLUS:

When is the rapid insulin administered?

A

After eating - allow flexibility with that we eat

22
Q

What regime is good if you don’t like injections

A

Premixed insulin, once, twice or three times daily

23
Q

PREMIXED INSULIN REGIME

Each injection contains

A

Basal component

Short-acting component

24
Q

PREMIXED INSULIN REGIME

possible regimes? (3)

A
  1. Once daily with largest meal
  2. Twice daily with breakfast and dinner
  3. Three times daily with each meal
    DO NOT GIVE AT BED TIME
25
Q

PREMIXED INSULIN REGIME

Advantage for raised BMI?

A

You can have three doses with meals (encouraged not to have afternoon snack)

26
Q

Insulins in order of action

A 
Shortest
Fast acting analogues
Soluble
Isophane
Detemir
Glargine
27
Q

Most common regiemes:

A

basal bolus
and
biphasic analogue mix

28
Q

REGIMES
Once daily insulin regime is ……..
must be administered….
and can be given with….

A

Long acting insulin (insulatard, glargine, levemir)

administer at same time each day

can be given in combo with OHA

29
Q

REGIMES
Twice daily regime is …

Disadvantage:

A

Short acting component controlling rise after eating breakfast and dinner

Snacks are needed to prevent hypos

30
Q

REGIMES

Twice daily regime is divide into

A

2/3 in the morning

1/3 eveing

31
Q

What regime do we want most patients to be on?

A

Basal bolus

32
Q

REGIMES

Basal bolus is

A

Long acting at the same time each day (usually bed)

Short acting just before meals (adjusted to exercise, carb count, BG)

33
Q

Carb counting ratio

A

1unit for 10g carbs

but you initially need to adjust to patterns to obtain a baseline

34
Q

Factors of influence in insulin (3)

A
  • length of needle
  • absorption from injection site
  • time of injection (crucial in hospital)
35
Q

What size needle should be used?

A

4mm

36
Q

How does weight affect insulin requirements?

A

drops as you lose weight

37
Q

How does illness affect insulin levels?

A

BG usually rises during illness

38
Q

How does climate affect insulin?

A

More rapidly absorbed in hot weather

39
Q

Needle advice (2)

A

don’t reuse

don’t go through clothes

40
Q

What happens in a night hypo?

A

Cortisole raises sugar when you wake so it looks like you need to increase your insulin dose

Clinical (32 decks)

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