Endocrine T1DM Flashcards
what is dm? and hows it measured
persistent hyperglycaemia.
by hba1c or fasting glucose
what 4 can dm be caused by?
DEFICIENT INSULIN SECRETION (TYPE 1)
RESISTANCE TO ACTION OF INSULIN (TYPE 2)
PREGNANCY (GESTATIONAL)
MEDICATIONS (SECONDARY)
whats meds may cause secondary dm?
corticosteroids and antipsychotics
DIABETES MELLITUS- DRIVING
All drivers w/ insulin must notify the DVLA. t/f?
true
drivers should be assessed on awareness of hypoglycaemia, what is this?
capability of bringing their vehicle to a safe controlled stop
group 1 drivers eg car and hatchbacks must have ADEQUATE awareness of hypoglycaemia i.e. no more than…
1 EPISODE OF SEVERE HYPOGLYCAEMIA WHILST AWAKE IN THE PRECEDING 12 MONTHS
GROUP 2 DRIVERS (HGV, bus, etc) must have FULL awareness of hypoglycaemia i.e. ..
MUST REPORT ALL EPISODES, INCLUDING IN SLEEP
NO EPISODES OF SEVERE HYPOGLYCAEMIA IN THE PRECEDING 12 MONTHS
group 2 drivers must use a BG meter with sufficient memory to store how much readings? amount of time
3 months worth
what must group 2 drivers do if having any visual complications or issues?
notify DVLA and not drive
advice form dvla on what drivers should always carry?
glucose meter and blood glucose strips
when must drivers check blood glucose levels
no more than 2 hrs before driving and every 2 hours while driving
what must blood glucose conc always be above while driving?
5mmol/L
what must drivers do if bg falls below 5?
take a snack
fast acting carb always keep in vehicle - eg glucose tabs, glucose dirnks, full sugar soft drink, sweets (not chocolate)
what BG level is considered hypoglycaemia while driving?
<4mmol/L
what to do if have hypo during driving
safely stop vehicle
switch off engine, remove keys, move from drivers seat
eat or dirnk suitable source of sugar
wait 45mins after BG returned to normal to continue journey
DO NOT drive if hypoglycaemia awareness lost and notify dvla
what causes the insulin deficiency in T1DM?
DESTRUCTION OF INSULIN-PRODUCING BETA-CELLS IN THE PANCREATIC ISLETS OF LANGERHANS
Most common before adulthood
FEATURES OF TYPE 1 DIABETES?
HYPERGLYCAEMIA (>11mmol/L)
KETOSIS
RAPID WEIGHT LOSS
BMI<25
AGE<50
FAMILY HISTORY OF AUTOIMMUNE DISEASE
TYPE 1 DIABETES- BLOOD GLUCOSE MONITORING
HOW MANY TIMES?
MONITOR AT LEAST 4 TIMES A DAY (including before each meal+before bed)
TYPE 1 DIABETES- BLOOD GLUCOSE MONITORING
TARGETS:
fasting
before meals
after meals
when driving
5-7 mmol/L on WAKING (fasting)
4-7 mmol/L fasting BG BEFORE meals at other times of the day
5-9 mmol/L 90mins AFTER eating
>5 mmol/L when driving
how many types of insulin regimes are there for t1dm?
multiple daily injection basal-bolus (first line)
biphasic (mixture)
continuous SC infusion (pump)
TYPE 1 DIABETES- MULTIPLE DAILY INJECTION BASAL-BOLUS REGIMEN
whena re the following given
BASAL?
AND
BOLUS?
BASAL (long/intermediate acting) OD or BD
AND
BOLUS (short/rapid acting) before meals
BASAL
1st LINE?
2nd LINE?
1st LINE? Insulin detemir BD
2nd LINE? Insulin glargine OD
basal insulin determir example
levemir
basal insulin glargine examples
lantus
toujeo
TYPE 1 DIABETES- BIPHASIC MIXTURES?
what 2 insulins are they a mixture of
SHORT-ACTING mixed with INTERMEDIATE insulin
how often a day biphasic mixtures injected therefore good fo which ppl
1-3 TIMES A DAY
who find absal bolus rgeimen difficult
examples of biphasic mixtures
novomix
humalog mix
TYPE 1 DIABETES- CONTINOUS SC INFUSION (insulin pump) good for which pts
who suffer w/ disabling hypoglycaemia/uncontrolled hyperglycaemia
(rlly bad hypos and hyperglycaemia not well controlled)
WHAT FACTORS INCREASE INSULIN REQUIREMENTS? SIT
stress
infection
trauma
(cause BG to rise so need insulin to bring it down)
WHAT FACTORS DECREASE INSULIN REQUIREMENTS? EIRIE
Exercise
Intercurrent illness
Reduced food intake
Impaired renal function
Endocrine disorders (thyroid, coeliac, addison’s)
why is insulin admin SC?
inactivated by GI enzymes
insulin is injected into body area with plenty of SC fat eg
abdomen (fast)
outer thighs/buttocks (slower)
why should you rotate injection site
Lipohypertrophy happens due to repeated injection sites into same area -> erratic insulin absorption
Cutaneous amyloidosis (amyloid protein under skin)
2 TYPES OF SHORT-ACTING INSULIN?
SOLUBLE
RAPID-ACTING
2 examples of SHORT-ACTING- SOLUBLE INSULIN
human + bovine / porcine
humulin/ hypurin
when to inject SHORT-ACTING- SOLUBLE INSULIN
15 - 30 mins before meals
onset and peak action of SHORT-ACTING- SOLUBLE INSULIN
30-60 min onset
peak at 1-4hrs
how long does duration last for SHORT-ACTING- SOLUBLE INSULIN
9 hrs
3 examples of SHORT-ACTING- RAPID-ACTING INSULIN
LAG
lispro/ aspart/ glulisine
aka
humalog/ novomix/ apidro
when to inject SHORT-ACTING- RAPID-ACTING INSULIN
immediately before meal
what is onset and duration of SHORT-ACTING- RAPID-ACTING INSULIN
<15 mins
2-5 hrs
INTERMEDIATE-ACTING INSULIN/BIPHASIC
EXAMPLE?
Biphasic isophane (humalog M3)
biphasic aspart (humalog mix)
biphasic lispro (isophane mixed with SA) (humalog mix)
what is onset, peak and duration for
INTERMEDIATE-ACTING INSULIN/BIPHASIC
ONSET? 1-2hr, peak 3-12hrs
DURATION? 11-24hrs
LONG-ACTING INSULIN
DDG EXAMPLE?
Detemir/Degludec/Glargine
levemir/ tresiba/ lantus, toujeo
when to inject LONG-ACTING INSULIN
OD
(but determir- levemir is BD)
what is onset and duration of LONG-ACTING INSULIN
ONSET? 2-4days to reach steady state
DURATION? 36hrs
