new tech Flashcards
pros and cons of basal bolus
pros
- achieve tight gkycaemic control
- flexible in what you eat
- freedom
cons
- more injections
-commitemnet to adherance
- hard for young children
DAFNE
dose adjustement for normal eating
strictured eductaional prgramme and social support
Also has an APP to log BG inslui taken and carbs eaten
recording can help spot patterns
My Sugr
APP to log diabetes stuff also rewards you for doing well can be motivating for patients
glucose buddy
support network for dianbteic patients
pros and cons of fingerprick testing
pros
- helps determine which foods are best for control
- helps inform patients and doctors about what injection regime
- inctease understanding and reduce anxiety about hypo
- important for dangerous tasks like driving
cons
-hurts
-expensive to nhs
-anxiety
- have to test atleast 5 times per day more if you excersixe
CGMS
continous glusocse monitoring system
-sticks capillary needle into your arm like a patch
measures glucose every 5 minutes
if hypo alarm goes off
also shows you where bg is heading
simple autoappliactor
DEXCOM pros and cons
pros
-simple to use
-alarms help especially with parents of young patients (linked to phone)
cons
-not funded by nhs so expensive
-time delsy
-too much info can cause overwhelm
Flash glusoce monitoring (freestyle libre)
capillary needle patch - scan the sensor to get reading
reading every minute and can link to phone
more affirdabke and avaialble through nhs
also has hypo alarm
insulin pump therapy
cannula attached to body
filled device with short acting insulin which you can control how much goes in
pros and cons of insulin pump therapy
pros
-no injections
-fewer large swings in BG
-improvement in hbac1
cons
- check BG every 3-4 hours
-change infusion site 2-3 days
-takes several nonths to optomise
artificial pancreas project -minimed 780g
a - insulin pump
b-cannula
c- glucose sensor
d- transmitter
smartguard tech
-variable personalised rate of insulin 24/7
-auto adjusts BG and corrects every 5 minutes
-can anticipate BG changes with predictive algorithm
-sensor can be worn for 7 continous days
-users have same glycaemic control of heakthy patients
advance bolus wizard
can recognised regularly eaten foods and autoadjust insulin
omnipod
disposable insulin pump that can connect via bluetooth to dexcom
last line treatment : pancreas transplant
2nd pancreas attactched to small intestine however destruction of b cells still does occur in new pancreas
usually kidney transplant occurs at same time (shows end stage renal failure linked to diabetes)
must take immunosuppressants and corticosterioids (steroids bad for pancreas but must take for translpant)
function of corticosteroids
interrupt multiple steps in immune activation because of the ubiquitous expression of corticosteroid receptors. Corticosteroids inhibit antigen presentation, cytokine production, and proliferation of lymphocytes. but delay emptying of pancreas
immunosuppressants taken by transplant patients
cyclosporin, tacrolimus, sirolimus,azathioprine, mycophenilatemofeti
pros and cons of islet transplant
pros
-no steroids
-only alemtuzumab
-improved HbA1c
-improved qol
-0 instances of hypo
cons
-lifelong immunosuppression (tac rolimus, sirolimus)
-islets in short supply
-transplanted cells do not provide infinite function eventually run out of steam
islet transplant (new)
isolate islets from donated pancreas and purify - these cells then injecteded into hepatic portal vein and lodge in the liver, thesethen function and regulate BG as usual cells
viacyte cell pouches
made of ePTFE (expanded polymer)
cells inside pouch can regukate blood glucose
release insulin
material repels immune system
PEC-ENCAP
cells inside derived from stem cells and pancreatic precursors
semi permiable so blood vessels can grow around pouch
PEC-Direct
blood vessels can grow insode pouch
do require immunosuppressants
suitable for uncontrolled t1D with extreme glycaemic lability
PEC-QT
experiemental atm
-same as PEC -DIrect
CRISPR modified cells
immune evasive (not recognised by immune system)
for anyone with t1or2d
crispr tech
allowd to modify genes within individual cells to make sell. surface apperance slightly different
uses cas9 enzyme to clip and edit genes (that we expect are causing bcell destruction)
-made with pluripotent cell cells
differentiated into pancreatic endoderm cells
-
teplizumab-tzeild
cd3 directed monoclonal antibody
bin ds to cd3 antigens on surface of t cell which deactivates pancreatic b cell autoreactive t cells
