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2ND YEAR SYSTEMS: Diabetes and Endocrinology > Lifestyle + exercise + self-management of Diabetes > Flashcards

Lifestyle + exercise + self-management of Diabetes Flashcards

1
Q

What sorts of things get in the way of managing a long term health condition (5)

A

Emotional well-being

Motivation

Importance

Health beliefs

Experiences

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2
Q

What is the national target for Type 1 diabetic glycaemic control

A

HbA1c level of 48 mmol/mol (6.5%) or lower

but everyone will have slightly different target - hard to keep it at national target

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3
Q

What is the secondary care HADS screening? What were the results

A

14 item outcome that measures anxiety and depression involvement with diabetes

15% anxiety
10% depression
8% both

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4
Q

Psychological issues associated with diabetes (4)

A

Anxiety & Stress

Depression & Low Mood

Adjustment problems

Eating-related & body image difficulties

all can lead to poor control

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5
Q

Why is stress so bad with diabetes

A

Stress makes blood glucose levels rise

This is because cortisol kicks in (fight or flight response) to raise energy for the body to survive and get away

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6
Q

Anxiety and diabetes

A

Worry; nausea; < focus; restlessness; shaking; muscular tension; sweating; avoidance

General anxiety (unrelated to diabetes) or Hypo fear

Deposits glucose in the blood + reduced insulin efficiency – stress reactivity varies though

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7
Q

What are some health beliefs?

A

The following tend to make a patient more active in controlling their disease:

knowing the seriousness of a condition

effectiveness of treatments

costs and benefits of following advice

self efficacy

vulnerability to future problems

impact of illness

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8
Q

What is the ABC of behaviour

A

Antecdents - situations, thoughts, feelings preceding

Behaviour - Target behaviour

Consequences - short, medium, + long term

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9
Q

Why might a patient not check their glucose levels

A

Not great readings make them feel anxious & not good enough

Don’t want to have to inject theirselves with needles

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10
Q

Example of ABC method of behaviour

A

A - Working in shifts, get home late, sick of having to deal with diabetes when others don’t, feeling angry and frustrated

B - Don’t take insulin

C - Short term - anger dissipates
Later -Wake up in the morning groggy, check blood glucose – very high, spend most of the day trying to balance and correct levels - more anger and frustration

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11
Q

How can we break well established habits in our behaviour

A

Stress reducing techniques
Online self-help/psychology/mindfulness

Involve key people in behaviour change
Friends; family; HC Practitioner

Use prompts – apps, alerts on phone

Importance (0-10) if important will be motivated to change; if not important then unlikely to change

Confidence in changing (0-10)

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12
Q

Behavioural changes can have what outcome?

A

Prevent disease

improve disease management

improve QOL

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13
Q

Why is diabetes so hard? (7)

A

Long term condition

Complex management

Lifestyle management – maintaining it is difficult

Delayed reward – good control reduces chance of complications but thinking ahead purely for benefits in the future is hard

Probabilistic reward – may still get complications, not 100% guaranteed.

No symptoms ? - can’t always tell when it is getting bad

It does not fit in with life - interferes with daily living

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14
Q

Why is diabetes specifically hard for young people? (10)

A 
Desire to be same as peers
Sport
Nights out
Alcohol / Drugs
Learning to drive
Leaving home
Festivals - need to keep medication chilled
Travel
Sex / Contraception - don't want to get pregnant with uncontrolled diabetes
Tattoos and piercings - impaired healing
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15
Q

How does an unhealthy lifestyle link in with type 2 diabetes

A

Type 2 Diabetes is an obesity related disease

Physical activity can prevent diabetes onset

Smoking increases risk of diabetes

Alcohol excess increases risk of diabetes

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16
Q

What is the main consideration in managing glycaemic control?

A

Carbohydrate intake

17
Q

Mediterranean diet model

A

Regular physical activity
H20 and herbal infusions good

Every main meal - fruit and veg. Olive oil, bread/pasta/rice/cous cous

Every day - dairy and olives/nuts/seeds. Herbs/spices/garlic/onions

Weekly - potatoes, white meat, red meat, eggs, sweets

18
Q

Describe a healthy food plate

A

1/3 fruit and veg

1/3 bread/rice/potatoes/pasta

last third split up between meat,fish,eggs,beans
food + drinks high in fat or sugar
milk and dairy foods

19
Q

What is the glycaemic index

A

Shows how quickly carbohydrate gets from your gut into your bloodstream

If it has a high GI then you get a peak in your [BG]

Adjustment of timing of insulin may be required for higher GI foods

20
Q

Why do T1 diabetic patients do carbohydrate counting

A

To work out how many carbohydrates they are about to eat in order to know how much insulin to take before the meal and whether they need a correction dose if their BG is already high

21
Q

Examples of some foods with high carbohydrate content

A

Cola
Jelly babies
Wine gums
Orange juice

22
Q

Examples of some foods with low carbohydrate content

A 
Butternut squash
Cherries
Grapefruit
Lentils
Parsnips
Peas
23
Q

What is Diabulimia

A

An eating disorder associated only with T1 diabetes

When someone stops taking their insulin to lose weight (No insulin - Glucose isn’t taken into fat cells to either be used or stored as fat)

Can result in recurrent DKA’s

Relatively common - affects 20% of women

High morbidity (poor control) and mortality

24
Q

Alcohol and diabetes

A

Alcohol reduces glycogenolysis (break down of glycogen stores - reduction in glucose)

Alcohol contains calories - results in a rise followed by a fall in glucose

Diabetics have the same limit as general population - more than 2-3 units at one time increases hypo risk

Advice is to have big meal before and a snack on way home or before bed

25
Q

Smoking and diabetes

A

Smoking increases risk of diabetes 1.5 times

Smoking increases risk of macrovascular disease (at least doubles)

People with diabetes at risk of ischaemic heart disease

Smoking increases risk of all complications

Nicotine replacement and other drugs can be used in diabetes

26
Q

Recreational drugs and diabetes

A

For uppers/downers and hallucinogenics:

Risk of DKA is much higher
Seizures
Cardiotoxic
Anxious
Sick
Munchies
Hyper/hypotension

Cognitive impairment - not going to be treating your diabetes in correct way

27
Q

Burden of physical inactivity: UK statistics

A
  1. 5% of coronary heart disease cases
  2. 7% of colon cancer cases
  3. 9% of breast cancer cases
  4. 0% of type 2 diabetes cases
  5. 9% of premature all-cause mortality
28
Q

Why shouldn’t you exercise straight after taking rapid acting insulin?

A

Rapid acting - causes quick drop in [BG]

During exercise – body burns glycogen – glucose released from glycogen stores basically – GB goes up at first

After exercise your muscles replenish their glycogen stores with glucose from the blood – drop in BG - even bigger due to first drop from insulin injection

more at risk of hypo

29
Q

What should you do if you’ve had a hypo in the last 24hrs (severe or not severe)

A

severe - do not exercise

not severe - risk of a hypo is higher so take extra precautions and don’t do lone events on that day

30
Q

What type of exercise is best for T1 diabetics

A

A mix of aerobic (BG decreases) and anaerobic (BG increases)

31
Q

How should a type 1 diabetic prepare for exercise

A

Reduce their insulin before and after (up to 24hrs)

Eat more - appropriate carbohydrate - reduce risk of hypo

reduce hypo risk - sprint at the end of exercise reduces this

32
Q

Driving and diabetes

A

Risk of hypos, poor vision, neuropathy (loss of sensation)

You can drive with diabetes but you must inform DVLA if you are on insulin

Since November 2011 allowed to apply for Group 2 licences if on insulin ie bus lorry - strict medical review

MUST WAIT 45 MINS AFTER HYPO TO START DRIVING AGAIN

SHOULD CHECK BG WITHIN 2 HOURS OF STARTING DRIVING

33
Q

Work/employment and insulin treated diabetes

A

Disability Discrimination Act 2010

Absolute exclusion - cannot work in the police or armed forces

Offshore work or blue light rapid response drivers may be off limits

34
Q

Travel and diabetes

A

No restrictions but use common sense and insurance premium
Monitor glucose
Drink plenty of fluids
Avoid risks of gastroenteritis
Always carry insulin with you (not hold luggage)
Adjust insulin to cross time zones

2ND YEAR SYSTEMS: Diabetes and Endocrinology (21 decks)

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