DIABETES

Question 1

• What triggers the development of Type 1 diabetes?

Answer 1

Autoimmune destruction of the pancreatic beta cells, resulting in inability to produce insulin. Immune system identifies these cells as foreign accidentally and destroys them. Some are born with genetic susceptibility to it. Then later an environmental trigger such as virus activates the genetic susceptibility to bring immune response that produce type 1 diabetes.

Question 2

• Name three (3) symptoms of Type 1 diabetes.

Answer 2

Nausea, Weight loss, vomiting, acetone smell.

Question 3

• Name three (3) symptoms of Type 2 diabetes and characteristics.

Answer 3

Blurred vision. Polyuria. Polydipsia. Characteristics of T2D = insulin resistance, and insulin secretion deficit.

Question 4

• State three (3) risk factors for Type 2 diabetes.

Answer 4

Obesity, Aging, Minorities [NZ Maori, Pacific].

Question 5

• Name one (1) test used to diagnose Type 2 diabetes.

Answer 5

HBA1C. Oral glucose tolerance test. To monitor – urine, HbA1c

Question 6

• State three (3) symptoms of hyperglycaemia.

Answer 6

Polyuria [excessive urination], Polydipsia [Excessive thirst], Polyphagia [Excessive hunger], dry mouth, fatigue.

Question 7

• What is hypoglycaemia and possible causes?

Answer 7

Hypoglycemia occurs when the level of glucose in the blood falls below 3.5mmol/l, usually as a result of an imbalance between food, physical activity and medication. Overdose of insulin, inadequate food intake, vomiting, frequent simple carbohydrate intake, strenuous exercise, infection

Question 8

• State three (3) symptoms of hypoglycaemia. early and late

Answer 8

Early – sweating, shaking, dizziness, hunger.

Late – double vision, unusual behaviour, confusion.

Question 9

• Describe the treatment of hypoglycaemia.

Answer 9

1 Check BGL [blood glucose level] and treat immediately
2 If unconscious treat with glucagon injection
3 When conscious administer 5 jelly beans
4 Check BGL and repeat treatment in 5-10 minutes if no affect
5 Once BGL rises, follow with longer acting carb food like 1 sandwich or fruit.
6 Repeat BGL test to ensure levels have improved.

Question 10

• Develop a teaching plan that identifies three (3) ways that Type 2 diabetes can be managed.

Answer 10

Healthy diet 
Exercise 
Weight loss
Oral hypo glycaemics
BP and lipid monitoring

Question 11

Management of T2D and T1D?

Answer 11

Management T2D – Healthy diet, exercise, weight loss.

Management T1D – Insulin, different types – short acting, long acting, fast acting

Question 12

• People with serious mental illness are more at risk of developing diabetes, HOW?

Answer 12

Atypical antipsychotic medications cause weight gain, hyperlipidaemia and insulin resistance causing diabetes
Atypical antipsychotic medications are associated with significant increases in fasting glucose concentrations

Question 13

• Develop a teaching plan that identifies three (3) ways that Type 2 diabetes can be managed.

Answer 13

Healthy diet 
Exercise 
Weight loss
Oral hypo glycaemics e.g. metformin = reduce glucose produced in liver 
BP and lipid monitoring

Question 14

• How does metformin work to reduce glucose levels in the blood?

Answer 14

Oral hypo glycaemics e.g. metformin = reduce glucose produced in liver

Question 15

• What blood glucose levels should people aim to sit within?

Answer 15

Blood glucose levels 4-8 mmol/l
Ideally 4-6mmol/l on waking
Ideally 4-8mmol/l rest of day
Elderly may be 5-10 mmol/l

Question 16

• Interventions for diabetics

Answer 16

Retinal screening
Foot screening
Clinical measurements: Blood pressure, Weight and BMI, HbA1c, Cholesterol, Creatinine, Electrolytes.
Other services to offer:
Advice and information on nutritional and lifestyle modification
Smoking cessation
Appetite for life
Diabetes group education classes
Green prescription
Health info
Identify high needs and high risk patients

Question 17

Many factors can contribute to hyperglycaemia, including:

Answer 17

• Insufficient insulin or oral diabetes medication
• Not injecting insulin properly or using expired insulin
• Diet
• Being inactive
• Illness or infection
• Certain medications, eg steroids, beta blockers
• Injury or surgery
• Experiencing emotional stress, such as family conflict or workplace challenges

Question 18

What to do if someone has Hypoglycemia

Answer 18

• Always a medical emergency
• Consequences
– Sympathetic arousal, collapse, confusion, seizure, coma, death.
• Needs IMMEDIATE treatment
• Once patient stabilised, consider the cause and try to prevent recurrence.

Question 19

Hypoglycaemia prevention

Answer 19

Frequent BSL monitoring
Monitor and encourage food intake
Anticipate changes in insulin requirements eg. fasting, changes in activity level
Give dextrose with insulin infusions*
Educate about symptoms of hypoglycaemia and encourage them to report these promptly.
Ask patients on insulin about their experience of hypoglycaemia and awareness threshold.

Question 20

Hypoglycaemia management and specify mmol’s

Answer 20

Patient conscious, and able to swallow safely
– Give 15-20g quick acting carbohydrate
– Test BSL after 10min
– If still <3.5mmol/L, repeat up to 3 times
– If still low, call for help, consider IV glucose or IM glucagon.
– Once BSL>3.5 give a snack or next meal if available

Question 21

Metabolic Syndrome / Defined as 3 or more of the following:

Answer 21

• Abdominal or visceral obesity(>102cm M, >88cm F)
• High triglycerides(ugly cholesterol)
• Low HDL(good) cholesterol
• High BP >130/80 (EPA SMI without DM 140/90)
• High fasting blood glucose

Question 22

Managing Type 2 Diabetes

Answer 22

• Healthy diet
• Exercise
• Weight loss
• Oral hypo glycaemics
• BP and lipid monitoring

Question 23

Hypoglycaemic Agents - state two

Answer 23

Biguanides / Metformin / REDUCE GLUCOSE IN LIVER

Sulphonylureas / Glipizide / Stimulate pancreas to release more insulin

Question 24

Insulin resistance what is it

Answer 24

• term used to describe the detrimental effect fat has on blocking available insulins ability to work properly
• fat blocks insulins ability to work effectively and efficiently
• High levels of insulin (that cant be utilised effectively) called insulinaemia
• Multi faceted, complicated mechanism/s and is a feature of the ‘metabolic syndrome’

Question 25

Barriers to preventitive care with patients who have mental illnesses [in diabetic care]

Answer 25

Less compliant with treatment, Severity of mental illness, Lack of social skills and communicating needs, migrant status or cultural ethnicity