Hypoglycemia And Insulin Treatment In Diabetes 07.12.23 Flashcards
What are the insulin therapies used in diabetes
Basal insulin and rapid acting analogues
How do the differences between T1DM and T2DM require a different approach to insulin therapy
Type 1
Autoimmune condition (β-cell damage) with genetic component
Profound insulin deficiency
Type 2
Insulin resistance
Impaired insulin secretion and progressive β-cell damage but initially continued insulin secretion
Excessive hepatic glucose output
Increased counter-regulatory hormones including glucagon
On the background of excessive energy intake
What is modern insulin therapy in type 1 diabetes
Separation of basal from bolus insulin to mimic physiology
Pre-meal rapid acting boluses adjusted according to pre-meal glucose and carbohydrate content of food to cover meals
Basal insulin should control blood glucose in between meals and particularly during the night
Basal insulin given as either twice daily insulin levemir (basal analogue or once daily degludec) adjusted to maintain fasting blood glucose between 4–7 mmol/L
Once-daily basal insulin (insulin medication) is given for type 1, type 2 diabetes or both?
Only in type 2
Twice-daily mix insulin (insulin medication) is given for type 1, type 2 diabetes or both?
Both type of diabetes
Basal-bolus therapy insulin (insulin medication) is given for type 1, type 2 diabetes or both?
Mainly used in type 1 diabetes, sometimes used in type 2
Advantages of basal insulin in type 2
Simple for the patient, adjusts insulin themselves, based on fasting glucose measurements
Carries on with oral therapy, combination therapy is common
Less risk of hypoglycaemia at night
Disdvantages of basal insulin in type 2
Doesn’t cover meals
Best used with long-acting insulin analogues which are considered expensive.
What organ systems does hypoglycaemia have pathophysiological effects on?
Brain (Cognitive dysfunction
Blackouts, seizures, comas
Psychological effects), musculoskeletal (Falls, accidents, driving accidents Fractures Dislocations), heart (Increased risk of myocardial ischaemia
Cardiac arrhythmias), circulation (Inflammation
Blood coagulation abnormalities
Haemodynamic changes
Endothelial dysfunction)
What are common autonomic, neuroglycopenic and non-specific symptoms of hypoglycaemia?
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What are causes of hypoglycaemia?
Long duration of diabetes
Tight glycaemic control with repeated episodes of non severe hypoglycaemia
Increasing age
Use of drugs (prescribed, alcohol)
Sleeping
Increased physical activity
What are the screening factors for severe hypoglycaemia?
Low HbA1c; high pre-treatment HbA1c in T2DM
Long duration of diabetes
A history of previous hypoglycaemia
Impaired awareness of hypoglycaemia (IAH)*
Recent episodes of severe hypoglycaemia
Daily insulin dosage >0.85 U/kg/day
Physically active (e.g. athlete)
Impaired renal and/or liver function
What is the treatment for hypoglycaemia?
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