Monitoring Diabetes

Question 1

What are the benefits of improved glucose control?

Answer 1

Decreased risk of micro and microvascular complications, as well as enhanced wellbeing

Question 2

What is HbA1c?

Answer 2

The largest component of all the glycated haemoglobins

Question 3

How is HbA1c formed?

Answer 3

A non-enzymatic glycation of haemoglobin on exposure to glucose

Question 4

What does HbA1c measure?

Answer 4

Average blood glucose over a prolonged period of time (6-8 weeks)

Question 5

Are HbA1c targets the same for every diabetic patient?

Answer 5

No

Question 6

What happens to the HbA1c target in older patients?

Answer 6

Lowered

Question 7

HbA1c above what indicates bad control?

Answer 7

> 75mmol/mol

Question 8

What are the benefits of good glucose monitoring?

Answer 8

Good control // Less symptoms of hypo/hyperglycaemia // Better lifestyle and exercise control

Question 9

What are the problems with glucose monitoring?

Answer 9

Painful, intrusive, discriminating

Question 10

What are some options for blood glucose monitoring?

Answer 10

Blood or urine ketones // Continuous glucose monitoring

Question 11

Are changes in glucose picked up quicker by testing the interstitial fluid or the blood?

Answer 11

Blood

Question 12

What blood glucose level is hypoglycaemia generally defined as?

Answer 12

< 3.5/4mmol/l

Question 13

What defines a severe hypo?

Answer 13

When the patient cannot correct the hypoglycaemia for themselves i.e. seizures, unconsciousness

Question 14

In terms of hormones, what would be the response to a decrease in blood glucose in a non-diabetic individual?

Answer 14

Decreased endogenous insulin // Increase in glucagon and adrenaline

Question 15

Can diabetic patients produce glucagon to reverse the action of insulin? Why/why not?

Answer 15

No // Most patient lose the production of glucagon within 5 years of the disease

Question 16

What is the relationship between HbA1c and hypoglycaemia?

Answer 16

As HbA1c decreases (and hence lower risk of microvascular complications), the risk of severe hypos increases

Question 17

50% of severe hypos occur when? Why?

Answer 17

Overnight // There is decreased awareness of warning signs and no counter-regulation from hormones

Question 18

What is the immediate treatment of hypoglycaemia?

Answer 18

Consume 15-20g of glucose/simple CHO // Recheck BG in 15 mins // If still low, repeat // When BG is back to normal, have a small snack if the next planned meal is more than 1 hour away

Question 19

If a hypo is severe, what management can be used?

Answer 19

1mg IM injection of glucagon into the arm/buttock/thigh

Question 20

When patients come around after being given a shot of glucagon, what may the experience?

Answer 20

Nausea and or vomiting

Question 21

Who gets decreased hypoglycaemia awareness?

Answer 21

Those with frequent hypos // Those with longstanding diabetes

Question 22

What are some rare causes of hypoglycaemia?

Answer 22

Primary failure of hormones to raise glucose // Prolonged insulin effects // Mismatch between insulin and nutrient absorption

Question 23

If a young, thin male presents with hypoglycaemia and vomiting, what should you suspect?

Answer 23

Addison’s