diabetes Flashcards
what causes diabetes
body is resistant to insulin or doesnt produce enough
what is diabetes insipidus- what are the different types
decrease in the amount of adh
means you cant hold water in your body resulting in excessive thirst and urination
2 types
cranial- problem with production of adh in the pituitary gland
nephrogenic- kidneys are resistant to ADH
What is the treatments for cranial diabetes insipidus
desmopressin or vasopressin- to replace the adh that isnt being produced
what are the treatments for nephtogenic diabetes insipidus
carbamazepine or thiazide like diuretic- paradoxcical effect
or oxytocin in nephrogenic/ partial pituitary diabetes
what is an extreme side effect that can happen with with vasopressin
extreeme dilutions of water leads to hyponatreamic convulsions
when do you have to notify the DVLA when you have diabetes
all drivers using insulin must report to DVLA
Iincluding if you have a hypoglycaemia epidoses or complications
drugs with greatest risk- sulphonyureas, meglitinides, insulins
what is the DVLA advice surrounding driving if pt is diabetic
aboid hypoglycaemia
carry glucose meter and test strips
carry sugar snack
check glucose 2 hours before and every 2 hours whilst driving
should always be over 5mmol when driving
take snack if below 5mmol and wait 45 mins
what advice should be given to diabetic patients about alcohol consumption
dont have to stop drinking
have with food and in moderation
alcohol can mask the symptoms of hypoglycaemia- confuison, tachy, hunger
what is the oral glucose tolerance test (OGTT) and what is it used for
diagnose impaired glucose intolerance
establish gestational diabetes
involves measuring blood glucose conc after fasting for 8 hrs then 2 hrs after drinking standard anhydrous glucose drink e.g polycal, OGTT oral
what is HbA1c used to diagnose
How often should it be measured for type 1 or type 2 pts
glycated haemoglobin
used to diagnose type 2 diabetes mellitus
also used to see if you might have macro complications
to see how well you have been managing ypur blood sugar in the last three months
performed at anytime of the day and with no preparation
expressed as mmol/mol
lower values are associated with vascular complications
individualised targets
monitor type 1 every 3-6 months or more frequently if rapidly changing
monitor type 2 pts every 3-6 months until stable then every 6 months
when should we not use hba1c
if pt is pregnant women within 2 months of women giving birth type 1 diabetes children symptoms of diabetes within 2 months actuely ill pancreatic damage, CKD, HIV Hyperglycaemia
what are the four different types of diabetes blood test and when they are used
tyoe 1 diabetes- random blood glucose test
type 2 diabetes- hba1c and fasting blood glucose test
oral glucose tolerance test- gestational diabetes
what is type 1 diabetes
insulin deficiency or no insulin secretion due to the destruction of insulin producing beta cells in the pancreatic islet of langerhans
autoimmune- any stage but mostly childhood
if hyperglycaemia poorly managed it leads to complications e.g retinopathy, nephropathy, neuropathy, premature CVD, PAD
What are the signs and symptoms of diabetes type 1
increased thirst frequent urination esp at night Hyperglycaemia - random glucose over 11 extreme hunger weight loss Irritability and other mood changes fatigue and weakness blurred vision
how many time should adults monitor their blood glucose in a day?
4 including before each meal and before bed time
what is the target HbA1c for type 1 diabetics
48mmol or below
6.5%
what is the target fasting glucose level on waking
wake up at 5 to 7
5-7mmol
what is the target plasma glucose level before meals and other times in the day
Be4 meals
4-7
whta is the target plama gluocse level after meals
dine at nine
5-9
what is the target plama glucose concentration when driving
five to drive
5 and over
what is the target random plasma glucose
less than 11
when is metformin appropriate to give to type 1 diabetics
pts with bmi over 25 or 23 if south asian who wish to improve glucose control and reduce insulin use
what is basal insulin
what is bolus insulin
slow and steady insulin released as background insulin that controls glucose continuoudly released from the liver
bolus secreted in repsonse to glucose absorbed by food or drink
what are the thre types of insulin
human insulin
human insulin analogue
animal insulin (bovine/porcine)
why is insulin given by injection rather than orally
where should it be injected
insulin is inactivated by the G.I enzymes
subcut fat area- abdomen (faster absorption rate), outer thigh or buttock
why should pts not inject the same area when admin insulin
lipohypertrophy
you should rotate the sites to minimise the risk
can cause erratic absorption of insulin and contribute to poor glycaemic control
name the short acting insulins
duration of action
and time to onset
When is it injected
injected immediately before meals 15 mins to onset- so inject 15 mins before meal lasts for 2-5 hrs examples: LAG Lispro- humalog Aspart- novorapid, fiasp Gluisine- apidra
name the short acting insulins- soluble
duration of action
and time to onset
when are they used over short acting rapid insulin
soluble I.V for diabetic emergencies S.C admin e.g ketoacidosis, peri-operatively 30-60 mins onset 9 hrs duration examples actrarapid humulin S Insuman
name the intermediate acting insulins
duration of action
and time to onset
when is it injected
before meals, biphasic, minic bassal basal insulin isophane= insulin and protamine time to onset is 1-2 hrs duration is 11-24 hrs \examples Isophan/NPH I humulin I Novomix Humalogmix, Humulin M3
name the long acting insulins
duration of action
and time to onset
which brands are used in type 2 diabetics
minic basal insulin time to onset 2-4 hrs duration of action 36 hrs determir and lantus used in type 2 dm Examples determir -Levemir OD-BD as add on to liraglutide Glargine - lantus, toujeo OD Degludec- tresiba OD
What is the basal bolus regimen
when are the injections taken
what are the benefits/ diadvantages
when is it first line
long acting/ intermediate and short acting
basal injected at meal times
bolus taken twice or once a day at bedtime
advantage- closer to normal secreion profile, dose can be adjusted to carbohydrate in meal
Disadvantage for children at school
first line for newly diagnosed type 1 diabetics. ideal for busy pts because it is flexible
can be used in type 2 diabetics
what is the once daily regimen
who is for
what are the insulins in it
once daily of insulin
for type 1 diabetics alongide tablets
Insulins long acting or intermediate Isophane NPH
long acting is Ideal for pts who have hyperglycaemia in the day andn night
inttermediate is ideal for patients who experience hyperglycsemia at night and in the morning- in this case taken at night
what is the mixed / biphasic regimen
taken once, twice or three times a day
asssuming you have 3 meals a day- have to stick to regimen
has soluble/rapid and intermediate
can be used by both type 1 and type 2
type 1; ideal for pts who are consitent with day to day routine which includs 3 meals at similar times each day e.g school kids- no need for lunch injections
type 2 pts: who experience hyperglycaemia after meals\
not for actutely ill pts or newly diagnosed type 1 diabetics
Recommend in type 2 diabetics
what is the continous subcut insulin infusion (insulin pump)
rapid or soluble insulin
delived by pump via cannula or subcut needle
only for adults who suffer from disabling hypoglycaemia or hugh HBA1C over 69 mmol
initiated by specialists
what factors can reduce insulin requirements or cause a hypo
impaired food intake,
vomiting
imapired renal function
endocrine disorders e.g addisons, physical activity
what can increase insulin requirements- risk of hyperglycaemia
infection
stress
accidental or surgical trauma
Pregnancy - 2nd/3td trimester
