Diabetes - tbc Flashcards
DM -Type 1 & Type 2, Pregnancy, surgery, complication, hyperglycaemic emergencies, hypos
Type 1 diabetes is
absolute insulin deficiency in which little or no endogenous insulin secretory capacity due to destruction of insulin-producing beta-cells in pancreatic islets of Langerhans. Has auto-immune basis in most cases, & occur at any age, but most commonly before adulthood.
Loss of insulin secretion = hyperglycaemia & metabolic abnormalities. If poorly managed; retinopathy, nephropathy, neuropathy, premature CVD, & peripheral arterial disease
Typical features in adult patients presenting with type 1 diabetes are
Hyperglycaemia (random BG >11 mmol/L)
Ketosis
Rapid weight loss, BMI <25 kg/m2
Age younger than 50 years, FHX of autoimmune disease (though not all features may be present).
HBA1c target for Type 1 DM
48 mmol/mol (6.5%) or lower
BG concentration aims for patient of Type 1 DM
1) waking
2) before meals
3) 90mins after meals
4) driving
1) fasting BG: 5–7 mmol/L on waking;
2) BG : 4–7 mmol/L before meals at other times of day;
3) BG: 5–9 mmol/L at least 90 minutes after eating;
4) BG: at least 5 mmol/L when driving
Type 1 diabetic monitor BG at least
x4 a day
Multiple daily injection basal-bolus insulin regimens
1 or more separate daily injections of intermediate-acting insulin or long-acting insulin analogue as the basal insulin; PLUS multiple bolus injections of short-acting insulin before meals
Mixed (biphasic) regimen
1, 2, or 3 insulin injections per day of short-acting insulin mixed with intermediate-acting insulin. ~ insulin preparations may be mixed by patient at time of injection, or premixed can be used.
Continuous subcutaneous insulin infusion (insulin pump)
Regular / continuous amount of insulin (usually in form of a rapid-acting insulin analogue or soluble insulin), delivered by programmable pump and insulin storage reservoir via subcutaneous needle or cannula.
Recommended insulin regimen for Type 1 diabetics
1st choice = multiple daily injection basal-bolus insulin regimens
What is insulin recommended basal-bolus insulin regimens for type 1 ?
BD ~ Insulin detemir (long-acting) unless already meeting agreed treatment goals on another insulin regimen.
OD~ Insulin glargine (100 units/ml)OD ~ if insulin detemir not tolerated, or if BD regimen not acceptable.
OD ~ Insulin degludec is alternative if concern about nocturnal hypoglycaemia.
OD ~ ultra-long acting insulin (insulin degludec, or insulin glargine 300 units/ml) as alternative in who need help with injection administration from carer or HCP
Is non-basal-bolus insulin regimens recommended for newly diagnosed type 1 diabetes ?
Non-basal-bolus insulin regimens (e.g. twice-daily mixed [biphasic], basal-only, or bolus-only regimens) NOT recommended in newly diagnosed type 1 diabetes.
Offer continuous subcutaneous insulin infusion (insulin pump) therapy to ,…
disabling hypoglycaemia or high HbA1c levels (69 mmol/mol [8.5%] or above) with multiple daily injection therapy
Persistent poor glucose control, leading to erratic insulin requirements or episodes of hypoglycaemia, may be due to
adherence, injection technique, injection site problems, BG monitoring skills, lifestyle issues (diet, exercise & alcohol), psychological issues, organic causes i.e. renal disease, thyroid disorders, coeliac disease, Addison’s disease or gastroparesis.
INCREASE insulin requirements due to
Infection, stress, accidental or surgical trauma
DECREASE insulin requirements due to
more risk of HYPO
~ physical activity, intercurrent illness, reduced food intake, impaired renal function, & in certain endocrine disorders.
Impaired awareness of hypoglycaemia
ability to recognise usual symptoms lost, or when symptoms blunted or no longer present.
Patients’ awareness of hypoglycaemia should be assessed
Annually using Gold score or the Clarke score.
what class of drug can impair hypoglycaemia symptoms
Beta blockers !!! by reducing warning signs such as tremor.
Diabetes mellitus is
group of metabolic disorders in which persistent hyperglycaemia caused by deficient insulin secretion or by resistance to the action of insulin. = leads to abnormalities of carbohydrate, fat and protein metabolism
Types of diabetes
Type 1
Type 2
Gestational diabetes
Secondary diabetes (caused by pancreatic damage, hepatic cirrhosis, or endocrine disease OR endocrine, antiviral, or antipsychotic tx)
DVLA advice for diabetes
~ if using insulin should always carry BG meter + test strips alwats
~ Check BG no more than 2 hours before driving & every 2 hours while driving.
~ BG should be at least 5 mmol/L while driving
~ if treated with insulin always have fast-acting carbohydrate with you.
~ If BG <4 mmol/L, or warning signs of hypoglycaemia develop, = NOT drive or stop vehicle, wait until 45 minutes after BG returned to normal (at least 5 mmol/L), before continuing their journey.
Notification to DVLA and monitoring of blood-glucose concentrations may also be necessary for some drivers taking like
oral antidiabetic drugs, particularly those which carry risk of hypoglycaemia (e.g. sulfonylureas, meglitinides).
Alcohol and diabetes
make signs of hypoglycaemia less clear, & cause delayed hypoglycaemia; drink less or with food
oral glucose tolerance test
measuring BG after fasting, and then 2 hours after drinking standard anhydrous glucose drink
~ for diagnosis of impaired glucose tolerance ONLY !!
~ can be also to test for gestational diabetes.
