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Dietetics written exam > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Types (4)

A

Type 1
Type 2
LADA
MODY

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2
Q

Type 1

A

Absolute insulin deficiency due to beta-cell destruction

No/little C-peptide

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3
Q

C-peptide

A

Marker of insulin production

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4
Q

Type 2

A

Relative deficiency or insensitivity to insulin

Use c-peptide volume for when to start insulin

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5
Q

LADA

A

Latent autoimmune diabetes in adults
Gradual onset of diabetes
Similar to Type 2

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6
Q

MODY

A

Mature onset diabetes of the young

Gene mutation

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7
Q

Consequences (6)

A 
CVD
Amputation
Pregnancy complications
Depression
Retinopathy
Neuropathy
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8
Q

DCCT study

Good control

A

Slows onset + progression of eye, kidney + nerve damage

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9
Q

Insulin

A

Take when CHO >10g
Work with individual so regimen suits lifestyle
Anabolic
Progressive weight gain problem when glycaemic control tightened

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10
Q

Insulin

Groups

A

Animal
Analogues
Human (synthetic)

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11
Q

Insulin

Storage

A 
Check expiry
Keep stock in fridge
Discard if out of fridge >28d
Never freeze
Away from heat
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12
Q

Insulin

Rapid acting analogues

A

2-5hrs
Children
Before/with or after food

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13
Q

Insulin

Mixed analogues

A

Medium insulin + rapid analogue

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14
Q

Insulin

Long-acting ANALOGUE

A

Once day
Background
Same time each day

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15
Q

Insulin

Short-acting

A

Humulin
15-30min before meal
Peak 2-6hr

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16
Q

Insulin

Medium-acting

A

Humulin I

20-30min before meal or bedtime

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17
Q

Insulin

Long-acting

A

Levemir
1 or 2 x/day
Background insulin

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18
Q

Injecting

A 
MDI
New needle each time
Under skin (not muscle)
Rotation sites to avoid lipohypertrophy
Stomach, buttocks, thighs
Don’t inject area if going to use (e.g. run)
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19
Q

Closed loop system:

CSII

A

Continuous subcutaneous insulin infusion

Pump therapy

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20
Q

Closed loop system:

Current pumps

A

Last 5y
Basal can be changed
Add insulin for food eaten
Check BG levels regularly

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21
Q

Closed loop system:

CGM

A

Continuous glucose monitor
Printout 24hr glucose levels
20min behind finger prick test

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22
Q

Closed loop system:

Cannula

A

Should be straight
Insert with device/needle
Change 2-4d

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23
Q

Other methods taking insulin

A

Inhaling - don’t know how much taken
Patches - insulin molecule too large
Tablets - broken down in stomach

Islet transplantation - still experimental

24
Q

Diagnostic criteria
HbA1c
Fasting BG
Random glucose

A

HbA1c >48mmol/mol
Fasting BG >7mmol/L
Random glucose >11.1mmol/L

Repeat test required for confirmation

25
Q

Adjusting insulin

Twice daily

A

Morning insulin affects dinner time BG

Evening insulin affects morning BG

26
Q

Adjusting insulin:

Long-acting analogue

A

Long time to adjust

Titrated up 2 units every 3d

27
Q

Adjusting insulin:

Rapid acting

A

Flexible

Adjusted by testing before + 2hr after meal

28
Q

Self BG testing

A

Finger prick test
Subtle changes not always felt
Accurate picture of BG levels
T1: 4x/d (before meals, before bed)

Tips - no soap, side of finger, rotate fingers, warm hands

29
Q

HbA1c

A

Measure of BG over past 3m
Target - Adults <48 and children <59
Higher = more glucose in circulation rather than going into cells

30
Q

Hypoglycaemia

A

When BG <4mmol/L
Unpleasant but not long term harm
Prevent with regular BG testing

31
Q

Hypoglycaemia

Treatment

A

15-20g quick acting CHO

  • 5 jelly babies
  • 1/2 can coke
32
Q

Hypoglycaemia:

Symptoms

A 
Headache
Sweating
Weakness
Confusion
(All caused by increased adrenaline)
33
Q

Hypoglycaemia

If continues to fall

A

Brain function impaired (drunk like behaviour)

Eventually may become unconscious

34
Q

Hyperglycaemia

A

> 7mmol/L (fasting)
Symptoms >11mmol/L

Can damage internal organs if long period time

35
Q

Hyperglycaemia

Causes

A

Stress
Illness
High CHO consumption
Missing insulin

36
Q

Hyperglycaemia

Symptoms

A

Increased

  • thirst
  • hunger
  • urination
37
Q

Ketoacidosis

A

Risk if BG >15mmol/L
Lack glucose so energy source switch to FA => ketone bodies
High ketone = severe illness
Detect ketones with finger prick test

38
Q

Ketoacidosis

Causes

A

Too little insulin

Miss meal

39
Q

Ketoacidosis

Symptoms

A 
N+V
Blurred vision
Pear drop smell
Dehydration
Coma
40
Q

Gastroperesis
Definition…
Insulin…
S+S…

A

Delayed gastric emptying
Nerves to stomach damaged/not working
High BG damages vagus nerve (controls movement)
Adds to difficulty of BG control
Insulin - eat then take, take more as smaller regular meals
S+S - N+V, weight loss, reflux, abdo bloating, decrease appetite

41
Q

Exercise

A

Always test BG beforehand

  • If <4 CHO snack + wait 15min
  • if >15 test for ketones

Don’t exercise if feeling unwell
Runsweet website for advice

42
Q

Ramadan

A

Muslim religious fast

Exemption if have diabetes

43
Q

Illness

A 
More insulin, fluid + testing
Test BG + ketone
Non-sugary fluid 100-200ml/hr
Continue to eat normal
If unable to eat solids - Ribena, Milk, Cola
44
Q

Aims of treatment

Adults

A

Insulin regimen to match routine/lifestyle

Need to know - patterns, exercise, preferences

45
Q

Aims of treatment

Children

A 
Prevent/treat complications
CV protection
Appropriate growth
Whole family
Weight management
Psychological - CAMHS
Centile + BMI charts
Adolescents - fads, alcohol, peer pressure
46
Q

Secondary causes

A 
Pancreatic disease
Endocrine disease
IBD
Insulin-receptor abnormalities
Genetic syndromes
47
Q

Enteral feeding

A

More basal insulin or insulin drip
Hyper common in hospitalised patients
May not be on normal insulin regimen
Optimise feed + ensure insulin there

48
Q

Cystic fibrosis

A

Prevalence CFRD increases with age of survival
Features T1 + T2
Regular screening
Insulin = treatment

Diet - CF > DM so adjust insulin to fit / high energy, fat + planned refined CHO

49
Q

Coeliac disease

A 
Most cases T1DM diagnosed before CD
Diagnosis - IgA blood test or biopsy
Symptoms vary between individuals
GF diet
Complications - growth failure, malabsorption, recurrent hyp
50
Q

NICE (2)

A

Low GI foods not recommended for BG control

Weight management advice if clinically indicated

51
Q

SIGN 2017 (3)

A

Smoking cessation
Alcohol <14u/wk
Structured education for those having hypo or failing to achieve glycaemic targets

52
Q

Diabetes UK recommendations

CHO

A

Main consideration for glycaemic control

Amount + type affect BG levels

53
Q

Diabetes UK recommendations

MDI + CSII

A

Benefit from adjusting insulin to CHO intake

54
Q

Diabetes UK recommendations

Fixed insulin regimen

A

Should consume consistent CHO quantities day-to-day

55
Q

Diabetes UK recommendations

Fibre

A

30g/d as with general population

56
Q

Diabetes UK recommendations

P.A

A

General health benefits but no evidence it benefits glycaemic control

Dietetics written exam (48 decks)

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