Chapter 6: Endocrine system COPY Flashcards
What is the advice from the DVLA regarding insulin dependent diabetic drivers?
- Should always carry a glucose meter and test strips when driving
- Check blood glucose no more than 2 hours before driving and then every 2 hours during driving
- Blood glucose should always be above 5 mmol/L whilst driving
- Should always ensure a fast-acting carbohydrate is available in the vehicle
- If blood glucose is <4 mmol/L, should NOT drive
This may also be the case in patients taking oral antidiabetic drugs, in particular those that cause hypoglycaemia
True or false:
Alcohol can cause delayed hyperglycaemia
False- can cause delayed HYPOglycaemia
Do you have to fast before a HbA1c test?
No
WHO:
HbA1c below 42 mmol/mol (6.0%): Non-diabetic
HbA1c between 42 and 47 mmol/mol (6.0–6.4%): Impaired glucose regulation (IGR) or Prediabetes
HbA1c of 48 mmol/mol (6.5%) or over: Type 2 diabetes
Is HbA1c used for monitoring glycaemic control in Type 1 diabetes, Type 2 diabetes, or both?
Both
Should not be used for diagnosis of Type 1
How often should HbA1c be measured in diabetes?
Every 3-6 months
If type 2 and stable, can be every 6 months
What is the recommended HbA1c target in Type 1 diabetes?
48 or lower
How often should blood glucose be measured in Type 1 diabetes?
At least 4 times a day
What are the blood glucose aims in Type 1 diabetes for:
a) Waking
b) Before meals
c) 90 minutes after eating
d) Driving
a) 5-7 on waking
b) 4-7 before meals
c) 5-9 at least 90 mins after eating
d) at least 5 when driving
What is a basal bolus insulin regimen?
One or more separate daily injections of intermediate-acting insulin or long-acting insulin analogue as the basal insulin; alongside multiple bolus injections of short-acting insulin before meals
What is a mixed (biphasic) insulin regimen?
One, two, or three insulin injections per day of short-acting insulin mixed with intermediate-acting insulin
What insulin regimen is first choice for Type 1 diabetics?
Basal bolus
Insulin detemir BD should be offered as the long insulin therapy
In a basal bolus regimen for Type 1 diabetes, what basal insulin would be first choice?
What would be the second choice?
Insulin determir BD - can also be offered as once daily
Once daily insulin glargine
Are non-basal bolus regimens recommended in newly diagnosed Type 1 diabetics?
No
Should only be considered after trying basal bolus regimen
In basal bolus regimen in Type 1 diabetes, what type of insulin is recommended for the bolus aspect?
Rapid acting insulin
Rather than soluble human or animal insulin
Continuous subcut insulin infusion therapy should only be offered to what group of people?
- Suffer from disabling hypoglycaemia
- High HbA1c of 69 or above with multiple daily injection therapy
What situations can cause an INCREASE in required insulin dose?
- Infection
- Stress
- Accidental/surgical trauma
What situations can cause an DECREASE in required insulin dose?
- Physical activity
- Intercurrent illness
- Reduced food intake
- Impaired renal function
- Certain endocrine disorders
Patients’ awareness of hypoglycaemia should be assessed annually using what score tools?
Gold or Clarke score
What cardiac class of drug can blunt hypoglycaemia awareness?
Beta blockers
Will reducing warning signs such as tremor
What is an impaired awareness of hypoglcyaemia?
Can occur when the ability to recognise usual symptoms of hypoglycaemia is lost, or when the symptoms are blunted or no longer present
What are the 3 types of insulin sources?
Human insulin
Human insulin analogues
Animal insulin
Which area of the body has the fastest absorption rate for insulin?
Abdomen
What can occur if you repeatedly inject insulin into the same area without rotating?
Lipohypertrophy
Can cause erratic absorption of insulin
How much time before meals do you administer short acting soluble insulin?
15-30 minutes before