Monitoring Diabetes Flashcards
What are the benefits of improved glucose control?
Decreased risk of micro and microvascular complications, as well as enhanced wellbeing
What is HbA1c?
The largest component of all the glycated haemoglobins
How is HbA1c formed?
A non-enzymatic glycation of haemoglobin on exposure to glucose
What does HbA1c measure?
Average blood glucose over a prolonged period of time (6-8 weeks)
Are HbA1c targets the same for every diabetic patient?
No
What happens to the HbA1c target in older patients?
Lowered
HbA1c above what indicates bad control?
> 75mmol/mol
What are the benefits of good glucose monitoring?
Good control // Less symptoms of hypo/hyperglycaemia // Better lifestyle and exercise control
What are the problems with glucose monitoring?
Painful, intrusive, discriminating
What are some options for blood glucose monitoring?
Blood or urine ketones // Continuous glucose monitoring
Are changes in glucose picked up quicker by testing the interstitial fluid or the blood?
Blood
What blood glucose level is hypoglycaemia generally defined as?
< 3.5/4mmol/l
What defines a severe hypo?
When the patient cannot correct the hypoglycaemia for themselves i.e. seizures, unconsciousness
In terms of hormones, what would be the response to a decrease in blood glucose in a non-diabetic individual?
Decreased endogenous insulin // Increase in glucagon and adrenaline
Can diabetic patients produce glucagon to reverse the action of insulin? Why/why not?
No // Most patient lose the production of glucagon within 5 years of the disease
What is the relationship between HbA1c and hypoglycaemia?
As HbA1c decreases (and hence lower risk of microvascular complications), the risk of severe hypos increases
50% of severe hypos occur when? Why?
Overnight // There is decreased awareness of warning signs and no counter-regulation from hormones
What is the immediate treatment of hypoglycaemia?
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
If a hypo is severe, what management can be used?
1mg IM injection of glucagon into the arm/buttock/thigh
When patients come around after being given a shot of glucagon, what may the experience?
Nausea and or vomiting
Who gets decreased hypoglycaemia awareness?
Those with frequent hypos // Those with longstanding diabetes
What are some rare causes of hypoglycaemia?
Primary failure of hormones to raise glucose // Prolonged insulin effects // Mismatch between insulin and nutrient absorption
If a young, thin male presents with hypoglycaemia and vomiting, what should you suspect?
Addison’s
