Monitoring of Diabetes

Question 1

Which complications were shown to be massively decreased in the DCCT?

Answer 1

Retinopathy 76%
Microalbuminuria 39%
Clinical neuropathy 60%
Massive reduction in microvascular
but increased risk of significant hypoglycaemia

Question 2

How is HbA1c formed?

Answer 2

Formed by non-enzymatic glycation of haemoglobin on exposure to glucose

Question 3

Which factors may influence HbA1C?

Answer 3

Up/down with Hemoglobin variants

Down with Hemolytic anemia, acute or chronic blood loss, pregnancy

Question 4

HbA1c level to diagnose diabetes

Answer 4

HbA1c ≥48mmol/mol (6.5%)

Question 5

Healthy target level for HbA1c

Answer 5

53mmol/mol (approx 40% have >75mmol/mol)

Question 6

What might you give in adjunct to glucose metre in T1DM?

Answer 6

Ketone metre

Question 7

What do ketone metres do?

Answer 7

Adjunct to glucose meter in T1DM
Measures levels of 3βOH-butyrate
Identifies early stages of ketone body formation
Identifies ‘insulin deficiency’
Allows preventative action to avoid ketoacidosis
Simple and clear ‘rules’

Question 8

How could you identify early stage of ketone body formation?

Answer 8

With a ketone metre

Question 9

Hypoglycaemic reactions

Answer 9

…….may first complain of hunger, or more often of a sense of weakness or fatigue and, especially if it his first reaction, he is conscious of anxiety, or of what he calls nervousness….. Almost constantly present is a feeling of tremulousness……..almost always a profuse sweat

Question 10

Symtpoms of hypoglycaemia

Answer 10

Headache
Shaking
Irritability
Sweating
Hunger
Confused
Vision
Anxious
Dizziness
Weakness
Fatigues
Fast heart rate (remember you've got loads of adrenaline)

Question 11

What classes as severe hypoglycaemia?

Answer 11

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

Question 12

15 grams of simple carbohydrate commonly used

Answer 12

glucose tablets (follow package instructions)
gel tube (follow package instructions)
2 tablespoons of raisins
4 ounces (1/2 cup) of juice or regular coca-cola (not diet)
1 tablespoon sugar, honey, or corn syrup
8 ounces of nonfat or 1% milk
Hard sweets, jellybeans, or gumdrops (see package to determine how many to consume)

Question 13

Immediate treatment of hypoglycaemia

Answer 13

Consume 15-20 grams of glucose or simple carbohydrates
Recheck your blood glucose after 15 minutes
If hypoglycemia continues, repeat.
Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away

Question 14

Treatment of severe hypoglycaemia

Answer 14

Glucagon 1 mg
Inject into buttock / arm or thigh
When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting

Question 15

Impaired hypoglycaemia Awareness

Answer 15

When hypoglycaemia occurs (4.0-3.5 mmol/l) and individuals feel no or a change symptoms.
Impaired Hypoglycemia Awareness occurs more frequently in those who:
frequently have low blood glucose episodes
Long duration type 1 or 2 diabetes
Intensively-treated type 1 diabetes (low HbA1c)

Question 16

What is the risk of intensely-treated type 1 diabetes (low HbA1c)

Answer 16

Impaired hypoglycaemia awarness

Question 17

What has led to the improvement of glycemic control?

Answer 17

Frequent blood glucose testing
Basal-bolus insulin regimes
Rapid acting insulin analogues
Long acting insulin analogues
Insulin pumps

Question 18

Structured education available for diabetics in Tayside to help prevent hypoglycemia

Answer 18

TIM/DAFNE

Question 19

At what blood glucose level will the counter regulatory hormones glucagon and adrenaline be secreted?

Answer 19

3.8mmol/L
Symptoms: 3.0mmol/L
Cognitive dysfunction: 2.8mmol/L