insulin Flashcards
drivers who are treated with insulin should always carry the following when driving, even if they use a continuous glucose monitoring system
capillary blood glucose meter
test strips
drivers who use a continuous glucose monitoring system who experience hypo symptoms or have a CGM reading of 4mmol/litre or below should confirm their BGC with….
capillary blood reading
when do blood glucose levels need to be checked before and during driving?
no more than 2 hours before
every 2 hours while driving
when may more frequent self monitoring be required for insulin users who are driving (normally needs to be no more than 2 hours before, and every 2 hours whilst driving)
if for any reason there is a greater risk of hypo e.g. after physical activity or altered meal routine
what does BG conc need to be whilst driving, and what should you do it if is less than this
needs to be at least 5 mmol/litre while driving
if between 4-5 take a snack
if below 4, treat hypo
what do all drivers taking insulin need to ensure is always available in the vehicle
fast acting carb
Glucose tablets, glucose drinks, full-sugar soft drinks or squashes, jellies (not diet), sweets
do not drive if….
BG 4 or below, or warning signs of hypo
what to do if you are driving and BG levels drop to 4 below or there are warning signs of hypo
stop vehicle in safe place ASAP and turn off engine
remove keys from ignition and move from drivers seat
wait until 45 mins after BG has returned to at least 5 before continuing journey
how long do you need to wait to drive after BG levels have returned to at least 5 to drive after warning signs of hypo developing/BG dropping to 4 or below?
45 mins
who needs to inform DVLA of their condition and needs to monitor BG levels before and during driving
- insulin
- may be necessary for some other oral anti diabetic drugs that hold risk of hypo e.g. meglitinides, SU
if the patient has lost hypoglycaemia awareness, but they are using CGM system and have capillary blood glucose monitor and test strips, are they allowed to drive
NO - cannot drive if hypoglycaemia awareness is lost! must inform DVLA. can resume if medical report confirmed awareness regained
group 1 drivers who have had more than one episode of severe hypoglycaemia while awake in the last 12 months
Must not drive and must notify DVLA
Group 2 drivers after every episode of severe hypoglycaemia in the last 12 months
Must not drive and must notify DVLA following all episodes of severe hypoglycaemia.
hypoglycaemia unawareness for group 2 drivers - DVLA guidance
Must not drive and must notify DVLA
The licence will be refused or revoked
will a group 1 drive have their licensed revokes if they have hypoglycaemia unawareness
no but they must not drive and must notify DVLA. driving may resume after clinical report by GP or consultant diabetes specialist confirms it has been regained
will a group 2 driver have their licensed revoked if they have hypoglycaemia unawareness
yes
DVLA advice for group 1 drivers who have temporary insulin treatment – including gestational diabetes or post-myocardial infarction
can drive and don’t need to notify DVLA as long as under medical supervision, and not advised by clinical as at risk of diabsliqng hypoglycaemia
- may drive but have to notify DVLA if disabling hypo occurs, or if treatment continues for >3 moths, or in gestation diabetes if treatment continues for 3 months after delivery
a patient is on insulin therapy for gestational diabetes. can she still drive and does she need to inform DVLA
can drive. doesn’t need to notify DVLA as long as she is under medical supervision and is not at risk of disabling hypoglycaemia.
can drive but does need to notify DVLA if disabling hypo occurs, or if treatment continues for 3 months after delivery
what is severe hypoglycaemia?
episode of hypo that requires assistance of another person
a maximum of …… should pass between pre-diving glucose test and first glucose test performed after driving started
2 hours
Natural profile of insulin secretion in the body:
Basal insulin (low and steady secretion of background insulin that controls glucose continuously released from liver
Meal time bolus insulin (secreted in response to glucose absorbed from food and drink)
3 types of insulin available in UK
Human insulin
Human insulin analogues
Animal insulin
Human insulin and insulin analogues are ….. immunogenic than animal insulins
less
What makes human insulin analogues different to human insulin?
Both produced by recombinant DNA tech
Both have same amino acid sequence as endogenous insulin
Analogues: modified to produce desired kinetic characteristics e.g. extended duration of action or faster absorption and onset of action
why can’t insulin be given PO
Inactivated by GI enzymes - must be given by injection, SC ideal in most circumstances
where does insulin need to be injected
Inject into a part of the body with plenty of SC fat
Abdomen - fastest absorption rate
Outer thighs, buttocks - slower absorption compared to abdomen or inner thighs
what body part has the fastest absorption rate when injecting insulin
Abdomen
is absorption at limb site injected the same
no.
absorption from limb site can vary (by as much as 20-40%) day to day, esp in children