Diabetes Management

Question 1

what are the target levels of blood glucose before food (preprandial)

Answer 1

4-7mmol/l

Question 2

what are the target levels of blood glucose at bedtime?

Answer 2

6-8mmol/l - higher at night to prevent hypoglycaemia through the night

Question 3

what nutrition advice would be given to type 1 diabetics?

Answer 3

• less than 10% of kcal should come from saturated fat

Question 4

how can type 1 diabetics monitor their blood glucose levels?

Answer 4

1-continuous blood glucose monitor -monitors and pt must actively administer insulin when required
2-closed loop glucose monitor- monitors and administers insulin when required

Question 5

what are the target levels of type 1 diabetic patients on a blood glucose test?

Answer 5

4-<7

Question 6

what are the target levels of type 1 diabetics on a hba1c test?

Answer 6

6-<10 %

Question 7

what is an acute type 1 complication?

Answer 7

hypoglycaemia
-may inject insulin without meal

Question 8

what are lifestyle management strategies in type 2 diabetics?

Answer 8

-weight loss
-dietary advice - less carbohydrates/sat fats

Question 9

what medications are used for type 2 diabetes control?

Answer 9

metformin- (obese patients- improves insulin response)
DDP-4- increases incretin- improves insulin response
GLP-1- increases incretin-improves insulin response
sulphonylureas- cause pancreas to secrete insulin- risk of hypoglycaemia

Question 10

what surgery is useful for type 2 diabetics

Answer 10

bariatric surgery- gastric sleeve

Question 11

what is an acute complication for type 2 diabetics ?

Answer 11

hypoglycaemia due to use of sulphonylureas- but more common in type 1

Question 12

what are chronic complication of type 2 diabetics?

Answer 12

microvascular complications
- poor wound healing
-easy wound infection
-eye disease
-renal disease
-neuropathy

macrovascular complications
-IHD
-MI
-claudication
-anneurysm

Question 13

how can type 2 diabetes affect the eyes?

Answer 13

damage to the retina
- cataracts- cloudy/milky-hazy vision-gradual not normal noticed-fixed with surgery
-retinopathy-microvessels thin walled and can haemorrhage- laser therapy to resolve

Question 14

how does type 2 diabetes affect nerves?

Answer 14

sensory neuropathy- peripheral numbness-cant feel damage-e.g numbness in feet-blisters-infection-necrosis

motor neuropathy-muscle weakening/wasting- bladder/bowel dysfunction

autonomic neuropathy- hypoglycaemia awareness, postural reflexes reduced (difficulty getting out of dental chair)

Question 15

what are the dental aspects of diabetes?

Answer 15

-dental appt may interrupt diabetic regime- LA may cause them to miss meal - always check they have eaten to prevent hypoglycaemia
-recognise medical emergency
-poor wound healing
-poor resistance to infection
-complications- eye disease, renal disease, neuropathy

Question 16

how does the 1 diabetes affect acute hypoglycaemia warning signs?

Answer 16

longterm diabetes cause autonomic dysfunction due to microvascular complications- meaning autonomic nerves are less able to send signals to warn of hypoglycaemic attack. Signals become closer together with less warning overtime.