Diabetes Flashcards
What is diabetes?
Group of metabolic disorders in which persistent hyperglycaemia is caused by:
deficient insulin secretion or
resistance to the action of insulin.
What are the common types of diabetes?
Type 1
Type 2
Gestational
Secondary diabetes (may be caused by pancreatic damage, hepatic cirrhosis, endocrine disease, antiviral, antipsychotics, endocrine)
What is type 1 diabetes?
Absolute insulin deficiency: no or very little endogenous insulin secretory capacity due to destruction of the insulin producing beta cells in the Islet of Langerhans.
What are the typical features of type 1 diabetes?
Hyperglycaemia (random plasma glucose concs > 11mmol/L)
KETOSIS (increase in ketones)
Rapid weight loss
BMI< 25KG/m2
< 50 years old
Personal or family history of autoimmune disease
What is type 2 diabetes?
Chronic metabolic condition characterised by insulin resistance.
Insufficient pancreatic insulin production occurs progressively over time.
Commonly associated with obesity, physical inactivity etc.
What are the aims of treatment for type 1 diabetes?
Using insulin regimens to achieve an optimal level of blood glucose control while avoiding or reducing frequency of having hypo episodes.
Minimise risk of macro/microvascular complications.
What are the treatment aims of type 2 diabetes?
Minimising the long term macro/microvascular complications by effective blood glucose control.
Maintain HbA1C at or below the target value set for each patient.
What are the signs of symptoms of hypoglycaemia?
Shaking and trembling Sweating Pins and needles Hunger Palpitations Occasional headache Double vision Slurring of speech CNS/cognitive issues (confusion, convulsions, unconsciousness, change in behaviour)
What is the initial management of hypoglycaemia IN COMMUNITY ?
1. Initially glucose 10-20g given by mouth in liquid form or sugar (2-4 teaspoons OR 3-6 sugar lumps) Repeat after 10-15 mins is necessary. 2. Non-diet version drinks: Original lucozade energy 110ml Coca-cola 100ml Ribena blackcurrent 19ml (to be diluted)
Quick acting carbs products: Glucogel, Dextrogel, GSF-syrup, Rapilose gel.
What is the management of hypoglycaemia after the initial management IN COMMUNITY ?
Sustainable snacks: sandwiches, fruits, biscuits, milk or the next meal if due (to prevent the blood glucose from falling again)
Is chocolate, high fat and sugary snacks a good choice for hypoglycaemia management IN COMMUNITY?
No,
Has higher fat content so glucose takes longer to have an effect.
What is the management of hypoglycaemia if patient is nil by mouth/ or unconscious IN COMMUNITY?
Glucagon 1mg IM or SC injection
What are the requirements for drivers with diabetes?
Tell the DVLA
Depends on their treatment, the type of license they hold, any diabetic complications including hypoglycaemia.
What type of patients MUST notify the DVLA about their diabetes?
Patients treated with insulin (due the higher risk of causing hypoglycaemia).
SU, nateglinde and repaglinde: carry a greater risk of hypoglycaemia, more monitoring required.
What is the DVLA advice for patients on insulin?
Always carry blood glucose meter and testing strips when driving.
Check BG concs no more than 2 hours before driving and every 2 hours while driving.
More frequent self monitoring required for greater risk of hypoglycaemia (after physical activity, altered meal routine etc)
Ensure there is a supply of fast acting carbs in the car.
What should the BG always be while driving?
5 mmol/L or over
What should be done if the BG falls below or equal to 5mmol/L? (DVLA)
Take a snack
What should happen if BG < 4mmol/l or war ning signs of hypoglycaemia while driving?
Do not drive.
If already driving: stop car in a safe place.
Switch of engine and remove the keys from ignition.
Move over to the passengers seat.
Eat or drink a suitable source of sugar.
WAIT 45 mins once BG has returned to normal.
Do not drive if hypoglycaemia awareness has been lost
Medical report needed to confirm that its been regained.
What is the oral glucose tolerance test (OGTT) used for?
- Used mainly for diagnosis of impaired glucose tolerance.
- Used to establish presence of gestational diabetes
- Can be used for those who have less severe symptoms and a BG that does not establish or exclude diabetes (e.g. impaired fasting glucose)
How is the OGTT performed?
Measure the BG concs after fasting, then 2 hours after drinking a standard anhydrous glucose drink (Polycal or Rapilose OGTT oral solution)
What does HbA1c test measure and are there any requirements?
It reflects the average plasma glucose over the previous 2-3 months and provides a good indicator of glycaemic control.
- It can be performed at any time of the day
- It does not require any special preparation like fasting
What is the units that Hba1c is expressed in?
mmol/mol
What is the Hba1c value for a non diabetic patient?
Less than 42mmol/mol (<6.0%)
What is the Hba1c value for a pre diabetic patient?
42-47mmol/mol (6.0-6.4%)