Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3M - Diabetes & Endocrinology > Management of Diabetes & Insulin > Flashcards

Management of Diabetes & Insulin Flashcards

1
Q

Aims of diabetes care

A

Prevention of life-threatening diabetes emergencies like diabetic ketoacidosis and hypoglycaemia.

Treatment of hyperglycaemic symptoms

Minimization of long-term complications

Avoidance of iatrogenic side-effects like hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outcomes of stringent glycaemic control

A

No hypo

Less complexity and polypharmacy

Lifestyle of metformin only

Short disease duration

Long life exp

No CVS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outcomes of less stringent control

A

Severe hyper

High burden of therapy

Longer disease duration

Limited life exp

Co-morbidities

CVS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain self-management education.

A

Educate about risks of diabetes.

Benefits of glycaemic control

Maintaining lean weight.

Stopping smoking

Taking care of their feet.

Exercise.

Diet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dietary advice in diabetes.

A

Low glycaemic index foods

Mediterranean style diet.

Reduce salt intake

Two portions of oily fish each week

Wholegrains, fruit and veggies.

Nuts and legumes.

Less red, processed meat and refined carbs.

Less sugary drinks.

Less saturated fats.

Limiting alcohol.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Explain glycaemic index.

A

Show how the durations of the carbohydrates.

Sugary drinks have a high glycaemic index.

Foods such as pasta will have a lower glycaemic index.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is carbohydrate counting important?

A

This is especially important in type 1 diabetes.

In order to optimize glycaemic control people need to match their insulin dose to the carbohydrates in the meal.

This is important to avoid hypoglycaemia or persistent hyperglycaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are foods with a low glycaemic index encouraged?

A

To prevent rapid swings in plasma glucose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give an example of a good program to manage a good diet and carbohydrate count.

A

Dose Adjustment for Normal Eating (DAFNE)’

Used in T1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is it important to lose weight in T2DM?

A

People who can be supported to lose 10-15kg of body weight through lifestyle, pharmacological or surgical treatment can enter remission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a treatment option for people with severe obesity?

A

Bariatric or metabolic surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Absorption rate of soluble human insulin.

A

Absorbed slowly reaching a peak 60-90 minutes after subcut.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risks of soluble human insulin.

A

Hypoglycaemia as its action tends to persist after meals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Explain the delayed absorption of soluble human insulin.

A

Soluble human insulin forms stable hexamers which need to dissociate to monomers or dimers before entering circulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is the delay in absorption a problem in diabetes?

A

Because the insulin should be injected 2-30 minutes prior to a meal.

This is often not feasible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give examples of short-acting insulin analogues.

A

Insulin lispro

Insulin aspart

Insulin glulisine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How have short-acting insuline analogues been engineered?

A

To dissociate more rapidly after injection.

They enter and disappear from circulation more rapidly than soluble human insulin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Benefits of short-acting insulin analogues in T1DM.

A

Reduces total and nocturnal hypoglycaemic episodes and improves glycaemic control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can action of human insulin be prolonged?

A

By addition of zinc or protamine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common form of Human insulin with Zinc or protamine.

A

NPH (Neutral protamine Hagedorn) / Isophane insulin.

An intermediate form of insulin!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Issues with NPH/Isophane insulin.

A

Variability from one injection to another.

Peak action might occur in the middle of the night.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give examples of long-acting analogues.

A

Insulin glargine (similar pH to subcutaneous pH = prolongs duration)

Insulin detemir (fatty acid tail binding to serum albumin)

Insulin degludec (forms long multihexamer chains at site of injection dissociating slowly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Benefit of long-acting insulin analogues.

A

Reduce hypoglycaemia risk for people with both T1DM and T2D particularly at night.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most common strength of insulin.

A

100 units/mL

Insulin glargine e.g. is available as 300 units/mL (U300)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Available concentrations of insulin degludec.

A

100U

200U

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the risk of withdrawing the insulin from the pen and administering it in a syringe instead?

A

Hypoglycaemia as pen devices indicate how many units of insulin are given.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When might U500 insulin be given?

A

In severe insulin resistance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Give examples of insulin regimens.

A

Basal-bolus regimen

Twice-daily mixed insulin regimen

Basal only insulin regimen

Basal-plus insulin regimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Explain basal-bolus regimen.

A

Administration of both short-acting and long-acting insulin.

Long acting is injected 1-2 times per day to provide a basal insulin to keep the glucose conc. consistent during periods of fasting.

Short acting is given shortly before a meal.

This regimen most closely mimics normal insulin physiology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

In which diabetes is basal-bolus regimen the tx of choice?

A

In T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Main disadvantage of basal-bolus regimen.

A

Number of injections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Explain twice-daily mixed insulin regimen.

(Also called BD biphasic regimen)

A

Mixture of short and lonc-acting insulin is injected before breakfast and the evening meal.

It’s a premixed insulin.

Novomix 30 is used e.g.

Useful in type 2 DM or type 1 with regular lifestyle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When might twice-daily mixed insulin regimen be used?

A

In type 2 diabetes.

Or in T1DM when you cannot inject 4 times a day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Main disadvantage of Twice-daily mixed insulin regimen.

A

Lack of a lunch-time bolus

Higher basal levels between meals.

Increased risk of hypoglycaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Explain basal-only insulin regimens.

A

Basal long-acting insulin at night and then non-insulin treatments during the day.

This can be used in T2DM.

It’s a good initial insulin regimen when switching from tablets in T2DM.

Consider retaining metformin if needed for tight control and patient is unable to use BD regimen.

36
Q

What types of administration of insulin exists?

A

Subcut by intermittent injection (syringe or more commonly a pen)

Insulin pumps

37
Q

Usual injection sites of insulin.

A

Front and outer upper side of thigh

Abdo wall

Buttocks

Upper outer arms.

38
Q

Benefits of insulin pens vs syringes.

A

More convenient

More accurate

Easier to use

Produce less painful injection

39
Q

Explain insulin pumps.

A

Continuous glucose monitors allow the pump to suspend insulin infusion if the glucose levels are low or predicted to become low.

40
Q

Benefits of insulin pumps in T1DM.

A

Improves glycaemic control

Reduces hypoglycaemia

Better quality of life

41
Q

Disadvantages of insulin pump.

A

Nuisance of being attached to a gadget

Skin infections

Risk of ketoacidosis if flow of insulin is interuppted

Cost

42
Q

Side effect of insulin injection in the same site.

A

Lipohypertrophy

43
Q

Cause of lipoatrophy due to insulin injections.

A

Immunoglobulin G immune complexes agains the insulin can be formed.

This can cause local atrophy of fat tissue.

44
Q

Side-effects of lipohypertrophy and lipoatrophy.

A

Interferes with insulin absorption.

Comprimising insulin action.

45
Q

Challenges of insulin therapy.

A

Therapeutic index of insulin is low.

Insulin req. are highly variable from one person to the other. Can also vary throughout the day in the same person.

Bolus insulin doses should ideally be adjusted to the carbohydrate content of the meal.

Carb counting can be difficult and requires maths.

Rate of absorption of glucose is affected by the glycaemic index.

No holidays from diabetes

46
Q

Aim of blood glucose levels.

A

4-7 mmol/l before meals

4-10 mmol/l after meals

47
Q

What should you do if the blood glucose is persistently too high before breakfast?

A

Increase evening long-acting insulin or pre-mixed.

48
Q

What should you do if blood glucose is persistently too low before breakfast?

A

Reduce evening long-acting or pre-mixed insulin.

49
Q

Blood glucose is persistently too high before lunch.

A

Increase morning short-acting or pre-mixed insulin.

50
Q

Blood glucose is persistently too low before lunch.

A

Reduce morning shortacting or premixed insulin

Can also have a mid-morning snack

51
Q

Blood glucose is persistently too high before evening meal.

A

Increase morning long acting or premixed insulin.

Or increase lunch short-acting.

52
Q

Blood glucose is persistently too low before evening meal.

A

Reduce morning long-acting or pre-mixed insulin.

Or reduce short-acting insulin of lunch.

Mid-afternoon snack.

53
Q

Blood glucose is persistently too high before bed.

A

Increase evening short acting or premixed insulin.

54
Q

Blood glucose is persistently too low before bed.

A

Reduce evening short-acting or pre-mixed insulin.

55
Q

Six steps of insulin safety.

A

Right person

Right dose

Right insulin

Right device

Right way

Right time

56
Q

Most common side-effects of insulin.

A

Hypoglycaemia (most common)

Weight gain

57
Q

Definition of clinically significant hypoglycaemia.

A

<3.0 mmol/L

58
Q

What is the recognised alert value of hypoglycaemia that requires treatment?

A

Any value below 4.0 mmol/l

59
Q

Definition of severe hypoglycaemia.

A

Hypoglycaemia requiring external help for recovery.

60
Q

In which diabetes is hypo more common?

A

T1DM

61
Q

In which patients does hypo more commonly occur?

A

In young children and those trying to achieve a tight glycaemi control.

62
Q

Psychological aspect of hypoglycaemia.

A

Impairs quality of life and induces fear and anxiety.

“Fear of hypo”.

63
Q

What is hypoglycaemia caused by?

A

Insulin over dose

Irregular eating habits

Unusual exertion

Alcohol excess

Insulin errors

Variation in insulin absorption

Lipohypertrophy

64
Q

Times of risk of hypo.

A

Before meals

During the night

During and after exercise

65
Q

Why does the mechanisms protecting against hypoglycaemia not work?

A

Abnormal islet cell function

Defective counter-regulatory hormone secretion

Glucagon secretion is impaired because its main regulator is a fall of intra-islet insulin.

66
Q

How can symptoms of hypoglycaemia be divided?

A

Into autonomic and neuroglycopenic symptoms.

67
Q

Which division of symptoms occur first in hypoglycaemia?

A

Autonomic symptoms.

This is due to activation of the adrenergic and cholinergic parts of the autonomic nervous system.

68
Q

Why is it important to note that autonomic symptoms appear before neuroglycopenic symptoms?

A

Because these symptoms alert the individual to hypoglycaemia and prompt them to take action before neuroglycopenic symptoms kick in.

When neuroglycopenic symptoms kick in the patient may be unable to correct the hypo themselves.

69
Q

What can happen in long-standing diabetes and repeated hypoglycaemic episodes?

A

The autonomic symptoms may only develop after neuroglycopenic symptoms.

This increases the risk of severe hypoglycaemia.

70
Q

Acute autonomic symptoms of hypoglycaemia.

A

Sweating

Paraesthesiae

Feeling hot

Shakiness

Anxiety

Palpitations

Pallor

71
Q

Acute neuroglycopenic symptoms.

A

Slurring of speech

Altered behaviour

Loss of conc.

Drowsiness

Low mood

Dizziness

Hemiplegia

Fits

Coma

Death

72
Q

Medical consequences of hypoglycaemia

A

Inreased risk of falls

Increased risk of MI

Increased thrombosis

Atherosclerotic plaque instability

Cardiac arrhythmias

Increased risk of hospitalisation

Increased risk of sudden death

73
Q

Psychological consequences of hypoglycaemia

A

Poor quality of life

Embarrassment

Fear of hypo -> reduced medication in future -> hyperglycaemia

74
Q

Financial consequences of hypoglycaemia.

A

Inability to work effectively

Increased out of pocket expenses

Increased medical costs

75
Q

Immediate hypoglycaemia treatment.

A

15-20g of oral glucose.

Repeated after 15 minutes if the glucose concentration has not risen above 4.0 mmol/l.

Liquid or solid food (fast acting carbs)

76
Q

How is the diagnosis of severe hypoglycaemia usually made?

A

Clinical grounds of confusion or coma e.g.

+

Bedside blood test

77
Q

How will diabetic patients let the general public that they have diabetes and will be of risk of hypo?

A

Usually carry a card or wear a bracelet or necklace saying that they have diabetes.

78
Q

Treatment of severe hypoglycaemia.

A

Intramuscular glucagon or intravenous glucose.

The glucagon acts by mobilising hepatic glycogen and works almost as rapid as glucose.

79
Q

When will IM glucagon not work?

A

When liver glycogen levels are low, e.g. after a prolonged fast.

80
Q

What should be given once the patient revives after a severe hypoglycaemic episode?

A

Eat some longer-acting carbs to replenish glycogen reserves.

81
Q

Why might weight gain occur in insulin treatment?

A

It’s an anabolic hormone.

It can also be due to frequent hypoglycaemia leading to a fear of hypo resulting in excess carbohydrates to treat or prevent the hypoglycaemia, this is called defensive eating.

82
Q

Explain the criteria required to have a driving license with diabetes and the associated hypoglycaemia that might happen.

A
83
Q

Explain subcutaneous insulin dosing during intercurrent illnesses like influenza.

A

Advise patients to not stop insulin during acute illness.

Illness often increase insulin requirements despite reduced food intake.

Maintain calorie intake like using milk.

Check blood glucose more than 4 times a day and look for ketonuria.

Increase insulin doses if glucose is rising.

Advise to get help from a specialist diabetes nurse or GP if concerned.

One option is 2 hourly ultra fast-acting insulin.

Admit if vomiting, dehydrated, ketotic, child or pregnant.

84
Q

Explain the management of T2DM algorithm.

A
85
Q

Treatment of hypoglycaemia.

A

If conscious => give 15-20g of quick-acting carbohydrate snack like 200ml orange juice.
Recheck blood glucose after 10-15 mins and repeat snack up to 3 times.

If conscious but uncooperative => Squirt glucose gel between teeth and gums.

If unconscious or not responding to tx => Glucose IVI (10% at 200ml/h if conscious or 10% at 200ml/15min if unconscious.
Or give glucagon 1mg IV/IM (will not work if malnourished)

Once blood glucose > 4.0 mmol/L and patient has recovered give long acting carbs.

Y3M - Diabetes & Endocrinology (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions