6: Monitoring of diabetes and hypoglycaemia Flashcards
Why is glycaemic control important in people with diabetes?
Better glycaemic control reduces your risk of microvascular complications
What are the three main microvascular complications of diabetes?
Neuropathy
Nephropathy
Retinopathy
An HbA1c level of 7% is equal to what in units?
53 mmol/mol
What are the main macrovascular complications of diabetes?
CVD
MI
Stroke
How do you explain HbA1c to a patient?
“Glycated haemoglobin”
i.e glucose sticking to your red blood cells, gives an indication of your blood sugar levels and therefore how well your diabetes is controlled
HbA1c indicates your average blood glucose level over a period of how long?
1.5 - 2 months
A normal (i.e non-diabetic) HbA1c level is less than __ mmol/mol.
42 mmol/mol
In pre-diabetes, HbA1c is between __ and __ mmol/mol.
42 and 47 mmol/mol
In uncontrolled diabetes, your HbA1c level is more than __ mmol/mol.
48 mmol/mol
Really poorly controlled diabetes is indicated by an HbA1c level of more than __ mmol/mol.
75 mmol/mol
What is a limitation of HbA1c?
Gives an average
so a person with wildly fluctuating hypers and hypos will have the same average as someone with an consistently elevated blood glucose level
Which type of insulin is preferred for treating T1 DM?
Analogue insulin
How is blood glucose most commonly monitored at the moment?
Pin prick test
What is the new development in glucose monitoring intended to replace pin prick testing?
Continuous glucose monitoring
How can you view the results of continuous glucose monitoring devices?
Computer
Phone (yours and others)
Pin prick testing measures ___ glucose.
Continuous glucose monitoring and flash monitoring measures ___ glucose.
Pin prick - blood glucose
Continuous / flash - interstitial glucose
The range of values for blood and interstitial glucose are different.
Which is more useful?
Interstitial glucose
What is a possible side effect of insulin overdose or sulphonylurea therapy?
Hypoglycaemia
What is the alert value for blood glucose concentration in hypoglycaemia?
4 mmol/mol
What are some symptoms of hypoglycaemia?
Tremor
Sweating
Anxiety
Dizziness
Hunger
Tachycardia…
Impaired vision, weakness, aggression…
What is the definition of severe hypoglycaemia?
Seizures
Unconsciousness
Inability to manage blood glucose yourself
Apart from insulin and glucagon, which other hormones are important in controlling blood glucose concentration?
Cortisol
Adrenaline
Growth hormone
Secretion of hormones controlling blood glucose concentration are controlled in what rhythm?
Circadian rhythm
Which pancreatic endocrinopathy causes hypoglycaemia?
Insulinoma
In people with Type 1 diabetes, the blood glucose threshold at which alpha cells produce glucagon (increases / decreases).
decreases
Aggressive treatment to prevent hypoglycaemia causes ___ and increases your risk of ___.
hyperglycaemia
microvascular complications
When does hypoglycaemia usually occur?
At night
What is the rough dosage of insulin per kg?
0.5 units / kg
A high HbA1c is a marker of someone who doesn’t ___ with their insulin regime.
comply
What is impaired hypoglycaemia awareness?
Hypoglycaemia where the patient doesn’t recognise the symptoms
Impaired hypoglycaemia awareness commonly occurs in which groups of patients?
Patients who:
a) frequently have hypos
b) have had diabetes for a long time
c) Type 1 diabetics who are being intensively treated
Why is hypoglycaemia a vicious cycle?
Sets threshold for symptoms lower each time, meaning you’re more likely to be hypoglycaemic more often, setting the threshold lower…
Why does recurrent hypoglycaemia increase your tolerance for hypoglycaemia?
Preconditioning
cellular make-up changes in response to new state
Tolerance to hypoglycaemia in Type 1 diabetes occurs in the state of (hyper/hypoglucagonaemia).
hyperglucagonaemia
What is habituation?
Reduced response to a stimulus as a result of repeated/prolonged exposure
e.g reduced response to hypoglycaemia
How is hypoglycaemia treated?
If conscious: 15-20g carbohydrate, recheck condition in 15 minutes
If unconscious: IV glucagon
+/- IV insulin afterwards
What are some of the most common causes of hypoglycaemia?
Insulin overdose
Sulphonylurea overdose
What disease, causing adrenal insufficiency, can cause hypoglycaemia?
Addison’s disease
