insulin and hypoglycaemia

Question 1

difference between basal and bolus insulin.

Answer 1

basal:
- background
- maintains constant level
- throughout night and in between meals

bolus:
- manages sugar spikes
- at meal times

Question 2

outline insulin therapy in T1D.

Answer 2

• pre-meal bolus - adjusted to glucose and carbohydrate content of food
• basal insulin either twice daily insulin insulin levemir or once daily degudec

Question 3

name the current insulin therapy.

Answer 3

hybrid closed-loop insulin therapy

Question 4

advantages and disadvantages of basal insulin.

Answer 4

advantages:
- Simple for the patient, adjusts insulin themselves
- Carries on with oral therapy, combination therapy is common
- Less risk of hypoglycaemia at night

disadvantages:
- Doesn’t cover meals
- Best used with long-acting insulin analogues which are expensive

Question 5

outline the advantages and disadvantages of pre-mixed insulin

Answer 5

advantages:
- both basal and bolus in single preporation
- can cover insulin requirements through most of the day

disadvantages:
- not physiological
- requires conistant meal and exerisize pattern
- cannot seperate individual components
- risk for nocturnal hypoglycaemia
- risk for hyperglycaemia if basal component does not last

Question 6

what are the 2 classifications of hypoglycaemia?

Answer 6

alert value - less than 3.9mmol/l

seriois - less than 3mmol/l

Question 7

name some risk factors for hypoglycaemia.

Answer 7

• long duration of diabetes
• history of previous hypoglycaemia
• recent epidodes of severe hypoglycaemia
• physically active
• impared renal and/or liver function

Question 8

how to treat hypoglycaemia.

Answer 8

• recognise symptoms
• less than 3.9mmol/l alert value
• treat with 15g fast-acting carbohydrates
• retest blood glucose value in 15 minutes and retreat if blood value is still below 4mmol/l
• eat long acting carbohydrate to prevent recurrance of symptoms