hypogylcaemia Flashcards
what is type 1 diabetes mellitus
Autoimmune condition (β-cell damage) with genetic component
Profound insulin deficiency
what is type 2 diabetes mellitus
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
3 different insulin approaches in diabetes
once daily basal insulin - for T2
twice daily mix insulin - for T1 & T2
basal bolus therapy - mostly for T1 but sometimes T2
advantages of basal insulin in T2 diabetes
- 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
disadvantages of basal insulin in T2 diabetes
- Doesn’t cover meals
- Best used with long-acting insulin analogues which are considered expensive.
advantages of pre mixed insulin for diabetes
- Both basal and prandial components in a single insulin preparation
- can cover insulin requirements through most of the day
disadvantages of pre mixed insulin for diabetes
- Not physiological
- Requires consistent meal and exercise pattern
- Cannot separately titrate individual insulin compononents1
- increased risk for nocturnal hypoglycaemia2,3
- increased risk for fasting hyperglycaemia if basal component does not last long enough
- Often requires accepting higher HbA1c goal of <7.5% or ≤8% (<58 or ≤64 mmol/mol)2,3
what is considered the best treatment for T1DM
Intensive basal-bolus insulin therapy
when should insulin be given in T2DM
Earlier insulin initiation is needed in people with T2DM
Many begin insulin therapy with HbA1c levels of ≥9%
what can reduce hypoglycaemia in T2 diabetes
a treatment approach in which basal insulin is added to oral therapy can improve glycaemic control and reduce hypoglycaemia but bolus insulin for one or two meals is often required
what is level 1 hypoglycaemia
alert value
Plasma glucose <3.9 mmol/l (70 mg/dl) and no symptoms
what is level 2 hypoglycaemia
serious biochemical
Plasma glucose <3.0 mmol/l
(55 mg/dl)
what is non severe symptomatic hypoglycaemia
Patient has symptoms but can self-treat and cognitive function is mildly impaired
what is severe symptomatic hypoglycaemia
Patient has impaired cognitive function sufficient to require external help to recover (Level 3)
is severe hypoglycaemia more common in T1 or T2
more common in insulin treated T2dm
