Diabetes Management Flashcards
What are the targets for blood sugar
Preprandial - 4 to 6 mol/L
Bedtime - 6 to 8 mol/L
Why is the blood sugar target higher at bedtime
To reduce the risk of hypoglycaemia
When is insulin used in diabetes management
Type 1 from diagnosis
Type 2 with inadequate control of oral meds
How is insulin injection carried out
Subcutaneous injection into any area of the body
Injection site often rotated as it leads to fat atrophy
Needle and syringe most often used
Insulin pen where patient can dial number of units required
How can diabetes management be broken down
Structured education appropriate to patients needs
Healthy living advice
Blood glucose management
Consider prevention to reduce risk - anti platelet drugs, statins and hypertensives
How is type 1 diabetes nutrition managed
Less than 10% of calories from saturated fats
Glycemic index allows patient to compare foods and maintain the same overall sugar level
Carbohydrate counting
How should exercise be carried out in type 1 diabetes
Planned activity as it will lower blood sugar which could lead to hypoglycaemia
What are the monitoring options for type 1 diabetes
Continuous glucose monitoring - device attaches to skin and needle monitored tissue fluid glucose levels subcutaneously
Closed loop glucose monitoring - monitors attach to an insulin pump which will change the amount of insulin delivered to the body in a continuous way
How can type 2 diabetes management be broken down
Lifestyle
Medication
Surgery
How can lifestyle manage type 2 diabetes
Weight loss
Diet restriction - avoid refined carbs, encourage high fibre food, reduce fats
What is the first line of drugs for type 2 diabetes and what do they do
Biguanides - metformin
Enhances cell insulin sensitivity and reduces hepatic gluconeogenesis
Preferred in the obese
What other drugs can be used to treat type 2 diabetes and what do they do
DDP-4 inhibitors - block the enzyme metabolising incretin
GLP-1 mimetics - increase the level of incretin
Sulphonylureas - increase pancreatic insulin secretion
What is the problem with sulphonylureas
Can cause hypoglycaemia
What are incretins and how can drugs to do with incretins help manage type 2 diabetes
Incretins are released from the stomach in response to sugar absorption and stimulate insulin release
If the enzyme metabolising them is blocked, they will stay in circulation for longer and improve the response of the body to glucose in producing insulin
What are the acute complications of diabetes
Hypoglycaemia
Will happen in type 1 if patient injects insulin but forgets to have an adequate meal
Type 2 patients can become hypoglycaemic if they have injected insulin or are on sulphonylureas
What are the chronic complications of diabetes
Cardiovascular risk due to macrovascular changes to blood vessels with increased atherosclerosis
Microvascular consequences lead to infection risk and neuropathy
Describe autonomic dysfunction in acute hypoglycaemia
Patient gets warning before hypoglycaemic episode - sweating, tremors and confusion - giving time to take some sugar
Once patient has been diabetic for some time, the microvascular changes bunch closer together so the patient receives little warning
What are large vessel complications of diabetes
Angina
MI
Claudication
Aneurysm
What are small vessel disease complications of diabetes
Poor wound healing Easy wound infections Renal disease Eye disease Neuropathy
What is neuropathy and how does it progress
Numbness of the feet - glove and stocking numbness
Long peripheral nerves lose function so patient doesn’t feel they have been wearing tight shoes, which rub, lead to blisters and become infected due to poor wound healing
Tissue requires to be amputated
What changes are seen in diabetic eye disease
Cataracts
Maculopathy
Proliferative retinopathy
What are cataracts and how are they fixed
White opacity within the iris suggests a cataract is present
Surgery is an easy fix
What is diabetic retinopathy
Changes to the blood vessels growing out across the retina
They proliferate and produce thin poor walled vessels which will then haemorrhage onto the back of the eye
How is diabetic retinopathy treated
Laser therapy where branches of the vessels are targeted and obliterated so that there is no longer any blood flowing through the weak walled areas to prevent damage in the long term
Why is fasting a problem in type 1 diabetes
The patient needs insulin to prevent ketosis and carbohydrates to prevent hypoglycaemia
What metabolic changes may diabetic patients experience in surgery
Hormone changes aggravate diabetes - adrenaline, cortisol, growth hormone
More glucose production and less muscle uptake
Metabolic acidosis more likely
Insulin requirements increased in type 1
Type 2 may require insulin cover perioperatively
What should a dentist be aware of for patients with diabetes
Food intake may be disrupted in dental treatment
Be aware of acute emergencies and management of hypoglycaemia
Be aware of complications such as ischaemic heart disease, potential for dehydration
Be aware of infection risk and poor wound healing