monitoring diabetes Flashcards
what is HbA1c
glycated haemoglobin
what does HbA1c measure
average blood glucose over a prolonged periodf of time (6-8 weeks)
normal HbA1c levels
below 42mmol/mol (6%)
pre diabetes HbA1c levels
42-47 mmol/mol (6-6.4%)
diabetes HbA1c levels
48mmol/mol (6.5% and above)
what is extremely poor HbA1c control
75mmol/mol and above (9% and above)
standard fingerprick test for people with diabetes
is good because they can use carbohydrate counting with it but is painful and obvious to everyone around them
targets of blood glucose level for type 1 diabetes before and after meals
before meals: 4-7mmol/l
after meals: 5-9mmol/l
targets of blood glucose levels for type 2 diabetics before and after meals
before meals: 4-7 mol/l
after meals: no more than 8.5 mmol/l
newer glucose monitoring
continous glucose monitoring system
hypoglycaemia is not
a diagnosis it is only a clinical sign
what is hypoglycaemia
when glucose levels fall below a certain point
for someone without diabetes when does hypoglycaemia occur
around glucose levels of 3.9mmol/l
for someone with diabetes when does hypoglycaemia occur
around 3mmol/l
severe hypoglycaemia
hypoglycaemia that leads to seizures, unconsciousness or the need for external assistance
glucose levels below 2mmol/l will cause
a coma
presentation of hypoglycaemia
- sweating
- tremor
- tachycardia
- palpitations
- anxiety
- nausea and vomiting
- blurred vision
- altered level of consciousness which can lead to a coma
in normal people the first thing that happens in response to hypoglycaemia is
the beta cells stop producing insulin and counter- regulatory hormones kick in to produce glucose (glucagon, cortisol, growth hormone, adrenaline)
whats the issue with hypoglycaemia in type 1 diabetics and why can’t the body fix it
because the insulin is from an exogenous source (insulin injections) so the body cannot stop it, and within 5 years people with type 1 DM lose there ability to produce glucagon so they hugely struggle to compensate
when do most hypos occur
50% occur overnight because the brain cannot activate normal counter-regulatory response in its normal way
management of a hypo in a conscious person
- 15-20g carbohydrates (glucose gel, half a cup of full fat coke)
management of a hypo in an unconscious person
glucagon injection in the community or if in hospital 50% IV dextrose
causes of hypoglycaemia
- diabetic related= too much insulin injected, sulfonylurea usage, insufficient food intake
- post prandial= dumping syndrome, galactosemia
- primary failure of hormone to raise glucose= hypopituitarism, addisons disease
- prolongation of insulin effects= exogenous insulin (factious disorder/ poisoning), hypothyroidism, liver failure)
- hyperinsulinomas
impaired hypoglycaemia awareness
when hypoglycaemia occurs (blood glucose falls below 4) but the individual feels no change
impaired hypoglycaemic awareness occurs more frequently in those who
- have frequent hypos
- long duration of diabetes
- intensively treated diabetes
repeated hypoglycaemia results in
a lower counter-regulatory response every time due to a process called pre-conditioning this increases the risk of severe hypoglycaemia and death occurring
