Diabetes Flashcards
What are the symptoms of diabetes?
Symptoms are usually present for three to four weeks before diagnosis. Common symptoms include polyuria and polydipsia. This is normally accompanied by marked fatigue, significant weight loss, and the development of a catabolic state. Patients may also notice blurred vision. High levels of glucose in the urine can lead to frequent infections in the urogenital system.
How is a diagnosis of diabetes made?
Diabetes is diagnosed on the basis of history (ie polyuria, polydipsia and unexplained weight loss) PLUS
a random venous plasma glucose concentration >= 11.1 mmol/l
OR a fasting plasma glucose concentration >= 7.0 mmol/l
If patient is asymptomatic then a diagnosis should not be based on a single glucose reading.
What are the four Ts of type 1 diabetes?
Toilet
Thirty
Tired
Thinner
What microvascular complications are associated with T1DM?
Retinopathy, nephropathy, and neuropathy
What macrovascular complications are associated with T1DM?
Premature cardiovascular, cerebrovascular and peripheral vascular disease.
What is diabetic ketoacidosis?
In the absence of insulin, glucose cannot be used by the body and the blood glucose levels rise. The liver responds by increasing hepatic glucose output via glycogenolysis and gluconeogenesis, worsening hyperglycemia. Insulin also suppresses lipolysis and so it is absence, fat is broken down. The resulting free fatty acids are converted into ketones in the liver. Ketones are acidic and their accumulation results in life-threatening systemic acidosis, This triad of hyperglycemia, ketosis, and acidosis is known as DKA.
What are the clinical features of DKA?
Nausea, vomiting, abdominal pain, drowsiness and in extreme cases, coma. Patients are often very dehydrated. And shortness of breath can occur as the body attempts to neutralize the metabolic acidosis caused by the ketones. Fruit smelling breath can also indicate the presence of excess ketones.
What are the advantages of rapid-acting insulin analogs over short-acting insulins?
The main advantage of rapid-acting insulin is the reduced risk of severe hypoglycemia. In addition, they can be injected just before a meal or immediately after (rather than 30 mins before). However, the are more expensive and demonstrate no real benefits over glycemic control.
What do you need to counsel patients taking intermediate-acting insulin on?
They are cloudy and therefore require mixing before administration (roll 20 times).
Given twice a day and does not need to be coordinated with meals.
What is meant by biphasic insulin?
Biphasic insulins contains are mixture of rapid or short acting insulin and an intermidiate insulin. The rapid/short component covers meals and the intermediate provides basal glycemic control.
Humalog Mix and Novomix are examples of what?
Analogue pre-mixed insulin
Which patients might be suited to a twice daily biphasic regimen?
Individuals whom keeping the number of daily injections to a minimum is an important factor in their quality of life.
The twice-a-day regimens can also help people who find adherence to lunchtime insulin injections difficult.
Adults with learning difficulties who require assistance from others.
Those who are prone to nocturnal hypoglycemia.
What size needles should be used to deliver insulin?
4 mm of 5mm
When might an insulin pump be used?
NICE recommends insulin pump therapy for adults and children age 12 years and older with T1DM, provided that attempts to achieve target HbAC1 with multiple daily injections have resulted in disabling hypoglycemia. Insulin pump therapy is also recommended if hbA1C has remained high (over 69mmol/mol) with multiple daily injections despite a high level of care.
How should patients with T1DM self monitor their blood glucose control?
It is not possible to standardise the frequency of blood glucose monitoring for all patients with T1DM because it is different for each patient.
There are many factors that determine the frequency of self blood glucose monitoring - driving status, the level of control required, patient preference, risk of hypo and illness.
More frequent monitoring is required for basal-bolus and insulin-pump treated patients.
Usually at a minimum 4 times a day - at each meal and before bed.
What do patients need to monitor their glucose levels more frequently when they are ill?
Glucose levels rise during illness, patient might not be eating as normal, vomiting/diarrhoea can alter levels.
