Diabetes Flashcards
Types (4)
Type 1
Type 2
LADA
MODY
Type 1
Absolute insulin deficiency due to beta-cell destruction
No/little C-peptide
C-peptide
Marker of insulin production
Type 2
Relative deficiency or insensitivity to insulin
Use c-peptide volume for when to start insulin
LADA
Latent autoimmune diabetes in adults
Gradual onset of diabetes
Similar to Type 2
MODY
Mature onset diabetes of the young
Gene mutation
Consequences (6)
CVD Amputation Pregnancy complications Depression Retinopathy Neuropathy
DCCT study
Good control
Slows onset + progression of eye, kidney + nerve damage
Insulin
Take when CHO >10g
Work with individual so regimen suits lifestyle
Anabolic
Progressive weight gain problem when glycaemic control tightened
Insulin
Groups
Animal
Analogues
Human (synthetic)
Insulin
Storage
Check expiry Keep stock in fridge Discard if out of fridge >28d Never freeze Away from heat
Insulin
Rapid acting analogues
2-5hrs
Children
Before/with or after food
Insulin
Mixed analogues
Medium insulin + rapid analogue
Insulin
Long-acting ANALOGUE
Once day
Background
Same time each day
Insulin
Short-acting
Humulin
15-30min before meal
Peak 2-6hr
Insulin
Medium-acting
Humulin I
20-30min before meal or bedtime
Insulin
Long-acting
Levemir
1 or 2 x/day
Background insulin
Injecting
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)
Closed loop system:
CSII
Continuous subcutaneous insulin infusion
Pump therapy
Closed loop system:
Current pumps
Last 5y
Basal can be changed
Add insulin for food eaten
Check BG levels regularly
Closed loop system:
CGM
Continuous glucose monitor
Printout 24hr glucose levels
20min behind finger prick test
Closed loop system:
Cannula
Should be straight
Insert with device/needle
Change 2-4d
Other methods taking insulin
Inhaling - don’t know how much taken
Patches - insulin molecule too large
Tablets - broken down in stomach
Islet transplantation - still experimental
Diagnostic criteria
HbA1c
Fasting BG
Random glucose
HbA1c >48mmol/mol
Fasting BG >7mmol/L
Random glucose >11.1mmol/L
Repeat test required for confirmation
Adjusting insulin
Twice daily
Morning insulin affects dinner time BG
Evening insulin affects morning BG
Adjusting insulin:
Long-acting analogue
Long time to adjust
Titrated up 2 units every 3d
Adjusting insulin:
Rapid acting
Flexible
Adjusted by testing before + 2hr after meal
Self BG testing
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
HbA1c
Measure of BG over past 3m
Target - Adults <48 and children <59
Higher = more glucose in circulation rather than going into cells
Hypoglycaemia
When BG <4mmol/L
Unpleasant but not long term harm
Prevent with regular BG testing
Hypoglycaemia
Treatment
15-20g quick acting CHO
- 5 jelly babies
- 1/2 can coke
Hypoglycaemia:
Symptoms
Headache Sweating Weakness Confusion (All caused by increased adrenaline)
Hypoglycaemia
If continues to fall
Brain function impaired (drunk like behaviour)
Eventually may become unconscious
Hyperglycaemia
> 7mmol/L (fasting)
Symptoms >11mmol/L
Can damage internal organs if long period time
Hyperglycaemia
Causes
Stress
Illness
High CHO consumption
Missing insulin
Hyperglycaemia
Symptoms
Increased
- thirst
- hunger
- urination
Ketoacidosis
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
Ketoacidosis
Causes
Too little insulin
Miss meal
Ketoacidosis
Symptoms
N+V Blurred vision Pear drop smell Dehydration Coma
Gastroperesis
Definition…
Insulin…
S+S…
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
Exercise
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
Ramadan
Muslim religious fast
Exemption if have diabetes
Illness
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
Aims of treatment
Adults
Insulin regimen to match routine/lifestyle
Need to know - patterns, exercise, preferences
Aims of treatment
Children
Prevent/treat complications CV protection Appropriate growth Whole family Weight management Psychological - CAMHS Centile + BMI charts Adolescents - fads, alcohol, peer pressure
Secondary causes
Pancreatic disease Endocrine disease IBD Insulin-receptor abnormalities Genetic syndromes
Enteral feeding
More basal insulin or insulin drip
Hyper common in hospitalised patients
May not be on normal insulin regimen
Optimise feed + ensure insulin there
Cystic fibrosis
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
Coeliac disease
Most cases T1DM diagnosed before CD Diagnosis - IgA blood test or biopsy Symptoms vary between individuals GF diet Complications - growth failure, malabsorption, recurrent hyp
NICE (2)
Low GI foods not recommended for BG control
Weight management advice if clinically indicated
SIGN 2017 (3)
Smoking cessation
Alcohol <14u/wk
Structured education for those having hypo or failing to achieve glycaemic targets
Diabetes UK recommendations
CHO
Main consideration for glycaemic control
Amount + type affect BG levels
Diabetes UK recommendations
MDI + CSII
Benefit from adjusting insulin to CHO intake
Diabetes UK recommendations
Fixed insulin regimen
Should consume consistent CHO quantities day-to-day
Diabetes UK recommendations
Fibre
30g/d as with general population
Diabetes UK recommendations
P.A
General health benefits but no evidence it benefits glycaemic control
