Diabetes 4 Flashcards
What type of blood glucose monitoring should be offered to patient to self manage their diabetes?
Continuous glucose monitoring (CGM)
- Intermittently scanned (flash) CGM (isCGM)
- Real-time CGM (rtCGM)
What is an example of an intermittently scanned (flash) CGM?
Freestyle Libre
What is a freestyle libre made up of?
A sensor and a reader
Who is capillary glucose monitoring for and how often must they use it?
Patients unwilling to or unable to use CGM and they must use it at least four times a day, including before each meal and before bed
Are blood glucose monitors available on the NHS?
No but test strips and lancets are, they are cheap to buy but proper instruction for use is needed
What are the target levels for type 1 diabetics in terms of HbA1c and glucose levels?
- HbA1c of 48 mmol/mol (6.5%) or lower
- glucose levels:
- fasting blood-glucose conc: 5-7mmol/l on waking
- before meals blood-glucose conc: 4-7mmol/l
- after meals blood-glucose conc: 5-9mmol/l at least 90 mins after
What treatment and lifestyle advice is available for type 1 diabetics?
Insulin therapy, healthy diet, regular exercise, diabetes education, regular check-ups at diabetes clinics
What were the results of the DCCT study?
- Intensive therapy reduced risk of complications
- Severe hypoglycaemia increased threefold (more tightly controlled sugar levels)
What were the overall conclusions of the DCCT and EDIC studies?
STRICT control of blood glucose can reduce the risk of MICROVASCULAR complications of type 1 diabetes (retinopathy, nephropathy, neuropathy)
What three insulin regimens are available for type 1 diabetes?
Basal-bonus, twice daily (biphasic insulin), Continuous subcutaneous infusion
What is the basal-bonus regimen?
- Bolus of Rapid-acting/short-acting insulin before breakfast, lunch and evening meal
- Injection of prolonged/intermediate action insulin once or twice daily
What are the advantages and the monitoring requirements of the basal bolus regimen?
Close to physiological insulin production and there’s great flexibility.
Regular and frequent blood glucose monitoring required
What is the NICE guidance for a basal-bolus regimen?
Multiple daily injection basal-bolus regimens
- Basal - twice daily insulin detemir
- Bolus - aspart, lispro or glulisine
What is the twice daily with biphasic insulin regimen?
Patient injects biphasic insulin twice a day (two thirds before breakfast, one third before evening meal)
What are the disadvantages of the twice daily biphasic insulin regimen?
Does not match physiological insulin
- Risk of hypoglycaemia between meals (snacks required)
Less flexible than basal-Bolus
What is the continuous sub-cutaneous infusion regimen?
Continuous sub-cutaneous infusion via an insulin pump, using short-acting or very rapid acting insulins
What is an advantage and two disadvantages of continuous sub-cutaneous infusion?
Physiological insulin delivery
Intensive patient education required and 24hr access to diabetes team necessary
According to NICE guidelines, only under what two instances can a patient be offered continuous sub cutaneous infusion?
- Patients who suffer disabling hypoglycaemia white trying to achieve target HbA1c
- Have high HbA1c levels after multiple daily injection therapy
What are closed loop systems and what is their advantage?
Insulin released automatically by pump in response to blood glucose levels detected by a rtCGM sensor
Adv: better glucose control, reduces the risk of hypoglycaemia
What instances might a patient might need to adjust their insulin dose?
- Pre-meal blood glucose reading
- Amount of carbohydrate required to be consumed
- Planned activity e.g. exercise
