diabetes meadhbh Flashcards
what is diabetes mellitus?
is a group of metabolic disorders in which
persistent hyperglycaemia (random plasma glucose more than 11.1 mmol/L) is caused by deficient insulin secretion, resistance to the action of insulin, or both
what is the difference between type 1 and type 2 diabetes?
Type 1: absolute deficiency of insulin
* Type 2: insulin resistance with relative deficiency of
insulin
what are the risk factors of diabetes?
Obesity and inactivity; diet; family history of type 2 diabetes; Asian, African, and Afro-Caribbean ethnicity; drug treatments such as long-term corticosteroids; and history of gestational diabetes.
what are the complications associated with diabetes?
Macrovascular: CVD including ischaemic heart disease, stroke and peripheral arterial disease
* Microvascular: chronic kidney disease, retinopathy, peripheral and autonomic neuropathy
* Foot problems- ulcer, deformity, infection
* Metabolic: dyslipidaemia, potentially life-threatening hyperglycaemic emergencies (diabetic ketoacidosis and
hyperosmolar hyperglycaemic state).
* Psychosocial impact: anxiety, depression, eating disorders, behavioural and emotional problems.
* Reduced life expectancy.
what lifestyle advice should be given to patient with diabetes?
diet, exercise, weight management
* Refer to retinal screening programme
* Annual foot checks
* Alcohol
* Smoking
what is type 1 diabetes?
Metabolic disorder characterised by hyperglycaemia due to
absolute insulin deficiency.
* The condition develops due to destruction of pancreatic beta
cells, mostly by immune-mediated mechanisms.
* Without insulin replacement, people with type 1 diabetes
would die within days or weeks.
how do you diagnose type 1 diabetes?
– hyperglycaemia random plasma glucose ≥11.1 mmol/L AND characteristic features
what are the typical signs of type 1 diabetes?
– ketosis
– rapid weight loss
– age of onset under 50
– body mass index (BMI) below 25 kg/m2
– personal and/or family history of autoimmune disease.
what are the targets for type 1 diabetes?
– Aim for HbA1c level of 48 mmol/mol (6.5%) or lower, to minimise the
risk of long-term vascular complications.
– Ensure HbA1c target is not accompanied by hypoglycaemia
what are the 3 different types of insulin regimens?
1,2,or 3 insulin injections per day
multiple daily injection
continuous subcutaneous insulin infusion
how does MDI regime work?
– Rapid- or short-acting insulin before meals
AND
– One or more separate daily injections of intermediate- or long-acting insulin analogue
how does CSII regime work?
– Portable electromechanical pump that gives basal infusion & individual bolus doses when required
what is first line insulin therapy?
Multiple daily injection basal–bolus insulin regimen
– Twice-daily insulin detemir as basal insulin
– Or
* Once-daily insulin glargine if insulin detemir is not tolerated or preference for once-daily basal injections
* Once-daily insulin degludec if concern about nocturnal hypoglycaemia or if need healthcare professional/ carer to administer
* AND Rapid-acting insulin analogues that are injected before meal
how often should you monitor blood glucose for type 1?
- Blood glucose monitor, lancets and test strips
- Routine self monitoring at least 4/day including before meals and bed
- Increase monitoring during illness, sport, driving, pregnant, frequent
hypoglycaemia
what are the targets for blood glucose monitoring?
waking- 5-7mmol/L
before meals+ other times of day- 4-7 mmol/L
after meals-90min- 5-9mmol/L
how do you flash monitor?
– Sensor on arm which lasts 14 days.
– Flexible and sterile fibre within the sensor is inserted in the skin to a depth of
5 mm.
– Draws interstitial fluid from the muscle into the sensor, where glucose levels are
automatically measured every minute and stored at 15-minute intervals for
8 hours
– Scan with smartphone app or meter reader
– Current glucose reading, previous 8 hours, trend
– Optional alarms for hypo/ hyperglycaemia
how do you continouus glucose monitor?
– Continuous glucose monitor.
– Sends signal to device/ mobile via bluetooth at 5-minute intervals.
– Sensor 10-14 days
what is hypoglycaemia?
When blood glucose levels fall to less than 3.5 mmol/L
* Levels where signs and symptoms appear may vary
* Cognitive function deteriorates when blood glucose levels fall to less than 3.0 mmol/L.
what is the signs of hypoglycaemia?
hunger, anxiety, palpitations, sweating, tingling lips, weakness, leathery, visual disturbances, confusion, convulsions, loss of consciousness, coma
how do you manage hypoglycaemia?
- 10–20 g of a fast-acting form of carbohydrate, preferably in liquid form as
this is easier to take– 3–6 glucose tablets - Recheck blood glucose levels after 10–15 minutes
– No response or an inadequate response, repeat as above and re-test blood
glucose levels after another 15 minutes - If the person is unconscious and unable to swallow (severe hypoglycaemia):
– Intramuscular (IM) glucagon should be administered immediately.
* Adults - 1 mg of glucagon should be given.
– If no response to glucagon treatment within 10 minutes, emergency transfer
to hospital should be arranged for treatment with IV glucose.
what is hba1c?
Measure of glycosylated haemoglobin
what is the aim for the hba1c?
Aim for HbA1c <48mmol/mol without disabling hypoglycaemia in type 1 diabetes
why is the target for the Hba1c set around that?
Targets set around balance between risk of hypoglycaemia & risk of long-term vascular complications
how often should you test Hba1c levels?
every 3-6 months
