Diabetes Treatment Flashcards
What are the different types of DM?
T1DM (beta cell destruction) T2DM (insulin resistance, beta cell dysfunction) Gestational DM T3c DM (pancreatic insufficiency) Steroid induced Diabetes MODY NDM
How is DM diagnosed in the PRESENCE of Sx?
Random plasma glucose < 11mol/L OR Fasting blood glucose > 7mmol/L OR 2hr plasma glucose >11mmol/L, 2hr after 75g OGTT
What Sx usually present for DM?
polyuria
polydipsia
weight loss
How is DM diagnosed in the ABSENCE of Sx?
Dx should NOT be based on one sample
2 samples on separate dates, of either: fasting, random, 2hr post-load
Which Dx criteria are often used for DM?
ADA 1997 diagnostic criteria
table that can be referred to
In the insulin deficient state, what metabolic compounds change?
- increased glucose
- increased FFAs (used as energy)
- increased lipase
- increased acetoacetic acid, cholesterol and TGs
What is the aim of insulin therapy?
- aim to normalise BMs
- prevent DM complications
- restore normal QoL
CAVEAT: can lead to hypoglycaemia
What is the relationship between hypoglycaemia and retinopathy risk? What does this mean?
inverse:
lower the risk of (severe) hypoglycaemia, the higher the risk of retinopathy
means that good glycemic control is NEEDED to minimise risk of retinopathy
How are exogenous insulin doses given to mimic endogenous secretion?
Basal level maintained with bolus (low, steady release of active insulin)
pre-prandial doses given, that are short-lived and rapidly acting
What are the normal endogenous insulin signalling patterns?
Biphasic insulin secretion
Two key elements:
- short-lived, rapidly generated peaks post-prandially
- Low/basal level of insulin to control glucose between meals
What are the short acting type of Insulin?
Actrapid
Humulin S
What are the different types of human insulin preparations?
- short acting
- rapid acting analogue
- medium and long acting insulin
- mixed insulins- long acting analogue mixture
- analogue mixture
What are the types of rapid-acting insulin in the UK?
- Novorapid (takes effect 10-20 mins after injection)
- Humalog (15-30’)
- Apidra (10-20’)
New Gen.
Fiasp. (~5’)
What are the types of basal insulins?
- Type 1 (Lantus, Levemir, Trojeo)
- Type 2 (intermediate acting (Humulin I, Insulatard)
- Gestational DM (intermediate acting, Humulin I)
- New generation (Degludec, Toujeo)
What are the 3 types of BD pre-mixed insulin regimes?
- once-daily basal insulin
- twice-daily mix-insulin
- basal-bolus therapy
What are the main types of error when administering insulin?
- prescribing errors
- delivery errors (of insulin in syringe to patient)
- dispensing error
What are the devices used for insulin delivery?
- insulin syringes
- cartridges for infusion pens
- pre-filled insulin pens
What are the side effects of using the same site for injection of SC insulin?
lipohypertrophy
What is the acute metabolic complication of insulin deficiency (T1DM)
DKA
- hyperglycaemia
- osmotic diuresis
- dehydration
- circulatory collapse
Caused by ketosis resulting in ketone body release
What are the ‘sick day rules’ for DM Mx?
- never stop insulin and check for ketones
- measure MBs 4x a day
- if BM < 11mol/L continues normal insulin
If BM 11-17 mol/L, add extra 4 units with meal - if BM >17mmol/L add extra 6 units with meals
- if nausea and vomiting and BM > 17mmol/L, call Dr
What are the benefits of using a intradermal continuous BM sensor?
- portable
- continuous monitoring
- Dr can monitor and discuss results with patients
What are common causes of hypoglycaemia?
- missed/delayed meals
- OD or mis-timed insulin or SU
- weight loss or frailty
- increased physical activity
- poor injection technique
- renal/hepatic impairment
- heat, EtOH, resolving infection
What are the autonomic signs of hypoglycaemia?
- hunger
- confusion
- sweating
- shaking
- dizziness
- tachycardia
Caused by adrenaline and GcG release
What are the neuroglycopaenic signs of hypoglycaemia?
- confusion
- drowsiness
- reduced coordination
- slurred speech
- atypical behaviour
- SEVERE: low GCS, coma, convulsions
