Diabetes Management Flashcards
What are the core areas of diabetes management?
- Education
- about diabetes
- managing diabetes
- health care issues
- complication avoidance - Targets (blood sugar)
- preprandial (before food) = 4-6mmol/L
- bedtime = 6-8 mmol/L - Reduce risk of associated diseases
When is insulin used in type 1 and type 2 diabetes?
- Type 1
- from diagnosis - Type 2
- with inadequate control on oral meds
What Insulin regimes have better/poorer control?
- Basal-bolus more injections
- better control - Split-mixed fewer injections
- poorer control
What healthy living advice might you give to a diabetes patient?
- Personalised diabetes management plans
- Dietary advice
- Lifestyle interventions where appropriate
What types of drugs are used as prevention to reduce risk of diabetes?
- Anti platelets
- Statins
- Anti hypertensives
What % of calories should be from saturated fat in a diabetic person?
10%
What is the advantage of a glycaemic index of different foodstuffs?
Allows broad comparison of the glucose load of one type of foodstuffs vs another
- this allows the patient to substitute different foods while maintaining diabetic control
Why does exercise need to be planned with a diabetic patient?
To avoid hypoglycaemia
- extra carbohydrates must be consumed to maintain blood sugar
What is the ideal blood sugar level?
HbA_1C (glycosylated blood) = 6<10%
What are two different insulin monitoring options?
- Continuous glucose monitoring
2. Closed loop glucose monitoring
How does continuous glucose monitoring work?
- Device attaches to skin
- Small needle monitors tissue fluid glucose levels sub cutaneously
- insulin levels are relayed to a monitor and the patient will be alerted of the insulin level breaches the target range
How does closed loop glucose monitoring work?
Monitor is attached to an insulin pump which varies the insulin dosage throughout the day based on subcutaneous sugar level
T2DM
T2DM
How is type 2 diabetes managed?
1.Primarily through lifestyle
- weight loss
- diet restriction
•avoid refined CHO
• encourage high fibre food
• reduce fat (especially saturated)
- Medication
- Surgery
- gastric vertical banding - bariatric surgery
What 4 main groups of medications are used to help manage type 2 diabetes and what are their functions?
- Biguanides - ‘metformin’
- first line drug for type 2 DM
- enhance cell insulin sensitivity
- reduced hepatic gluconeogenesis
- preferred one obese - DDP-4 inhibitors (Gliptins)
- block the enzyme metabolising incretin
- improves insulin response to glucose
- reduces liver gluconeogenesis and delays stomach emptying - GLP-1 mimetics
- increase the level of incretin
- injection daily/weekly
- same effects as DDP-4 inhibitors - Sulphonylureas
- increase pancreatic insulin secretion
- can cause hypoglycaemia
What types of patients is insulin used for in type 2 DM?
- In patients unable to maintain glycaemic control with
- behavioural changes
- body weight reduction
- oral hypoglycaemic agents
What are acute and chronic complications of diabetes?
- Acute - hypoglycaemia
- type 1
- type 2 on sulphonylurea or insulin
- insulin/drug without food - Chronic
- cardiovascular risk
- infection risk
- neuropathy
What type diabetes patient is at most risk of hypoglycaemia?
- Insulin treated patients with type 1 diabetes
What symptoms are a sign of hypoglycaemia?
- Adrenaline release
- Sweating, tremor
- start of brain dysfunction occurs - Confusion/loss of concentration
- Coma/seizure
- permanent brain damage occurs
What blood vessel complications can occur with diabetes?
- Large vessel - atheroma
- angina and MI, claudication, aneurysm - Small vessel disease
- poor wound healing
- easy wound infections
- renal disease
- eye disease
- neuropathy
What specific conditions occur in diabetic eye disease?
- Cataracts
- patient often has hazy vision
- look for whitening of pupils - Maculopathy
- loss of high density cone section of the retina
- results in loss of detailed vision - Proliferative retinopathy
- blood vessels grow across the back of the retina
- these may then burst and cause haemorrhaging onto the back of the retina and gradual obliteration of the visual part of the eye
How is diabetic retinopathy treated?
Laser surgery is used to destroy weak walled branches of blood vessels that have proliferated over time
Describe consequences of diabetic neuropathy
- General sensation
- glove and stocking - Motor neuropathy
- weakness and wasting of muscles - Autonomic regulation
- awareness of hypoglycaemia lost
- postural reflexes
- bladder and bowel dysfunction
What are complications of surgery for a diabetic patient?
- Fasting is a problem in type 1
- need insulin to prevent ketosis
- need CHO to prevent hypoglycaemia - Metabolic changes associated with surgery
- hormone changes aggravate diabetes
• epinephrine, cortisol, growth hormone
- more glucose production and less muscle uptake
- metabolic acidosis more likely
- increased insulin requirements in T1DM
- T2DM may require insulin cover after operation
What are dental aspects of diabetes?
- Be aware of effect of dental treatment
- food intake may be disrupted - Be aware of acute emergencies
- Be aware of diabetic complication
- IHD, dehydration, neuropathy, eyes - Be aware of infection risk
- Be aware of poor wound healing
