monitoring diabetes

Question 1

what is HbA1c

Answer 1

glycated haemoglobin

Question 2

what does HbA1c measure

Answer 2

average blood glucose over a prolonged periodf of time (6-8 weeks)

Question 3

normal HbA1c levels

Answer 3

below 42mmol/mol (6%)

Question 4

pre diabetes HbA1c levels

Answer 4

42-47 mmol/mol (6-6.4%)

Question 5

diabetes HbA1c levels

Answer 5

48mmol/mol (6.5% and above)

Question 6

what is extremely poor HbA1c control

Answer 6

75mmol/mol and above (9% and above)

Question 7

standard fingerprick test for people with diabetes

Answer 7

is good because they can use carbohydrate counting with it but is painful and obvious to everyone around them

Question 8

targets of blood glucose level for type 1 diabetes before and after meals

Answer 8

before meals: 4-7mmol/l

after meals: 5-9mmol/l

Question 9

targets of blood glucose levels for type 2 diabetics before and after meals

Answer 9

before meals: 4-7 mol/l

after meals: no more than 8.5 mmol/l

Question 10

newer glucose monitoring

Answer 10

continous glucose monitoring system

Question 11

hypoglycaemia is not

Answer 11

a diagnosis it is only a clinical sign

Question 12

what is hypoglycaemia

Answer 12

when glucose levels fall below a certain point

Question 13

for someone without diabetes when does hypoglycaemia occur

Answer 13

around glucose levels of 3.9mmol/l

Question 14

for someone with diabetes when does hypoglycaemia occur

Answer 14

around 3mmol/l

Question 15

severe hypoglycaemia

Answer 15

hypoglycaemia that leads to seizures, unconsciousness or the need for external assistance

Question 16

glucose levels below 2mmol/l will cause

Answer 16

a coma

Question 17

presentation of hypoglycaemia

Answer 17

• sweating
• tremor
• tachycardia
• palpitations
• anxiety
• nausea and vomiting
• blurred vision
• altered level of consciousness which can lead to a coma

Question 18

in normal people the first thing that happens in response to hypoglycaemia is

Answer 18

the beta cells stop producing insulin and counter- regulatory hormones kick in to produce glucose (glucagon, cortisol, growth hormone, adrenaline)

Question 19

whats the issue with hypoglycaemia in type 1 diabetics and why can’t the body fix it

Answer 19

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

Question 20

when do most hypos occur

Answer 20

50% occur overnight because the brain cannot activate normal counter-regulatory response in its normal way

Question 21

management of a hypo in a conscious person

Answer 21

• 15-20g carbohydrates (glucose gel, half a cup of full fat coke)

Question 22

management of a hypo in an unconscious person

Answer 22

glucagon injection in the community or if in hospital 50% IV dextrose

Question 23

causes of hypoglycaemia

Answer 23

• 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

Question 24

impaired hypoglycaemia awareness

Answer 24

when hypoglycaemia occurs (blood glucose falls below 4) but the individual feels no change

Question 25

impaired hypoglycaemic awareness occurs more frequently in those who

Answer 25

• have frequent hypos
• long duration of diabetes
• intensively treated diabetes

Question 26

repeated hypoglycaemia results in

Answer 26

a lower counter-regulatory response every time due to a process called pre-conditioning this increases the risk of severe hypoglycaemia and death occurring