New technologies in Type 1 diabetes Flashcards
what is the basal bolus regime
involves taking long acting insulin to keep blood glucose levels stable through periods of fasting and short acting insulin in between meals to prevent rises in blood glucose
- NICE gold standard
what are the advantages of the basal bolus regime
- flexibility with food/exercise
- freedom to make food choices
- tighter control, leading to lower HbA1C and less complications
what are the disadvantages of the basal bolus regime
- more injections
- commitment
- difficult in young children
what is DAFNE
Dose adjustment for normal eating
- programme to help patients get used to insulin injections
- provides peer support
- helps patients have a record of the pattern of their blood glucose
what does DAFNE achieve
- improved blood glucose control without risk of severe hypoglycaemia
- reduced negative impact of diabetes on quality of life
- improved treatment satisfaction
when is finger prick blood glucose monitoring used
- 38 meters on market
- minimum of 5 tests a day
- more frequent testing with exercise or illness
what are the advantages of finger prick blood glucose monitoring
- helps determine which foods are best for individual control
- helps inform the patient and doctor about injection regimes
- increases understanding and decreases anxiety about hypoglycaemia
- vitally important for undertaking dangerous tasks (driving, operating machinery)
what are the disadvantages of finger prick blood glucose monitoring
- requires willingness and commitment
- it is painful
- expense to the NHS
- overtesting can cause anxiety about blood glucose control and general health
what are the advantages of Continuous glucose monitoring systems
- not painful
- hypo alarms for safety
- linked to parents phone/devices for safety
- downloadable data for both patient and health teams
what are the disadvantages of Continuous glucose monitoring systems
- not currently funded by NHS
- expensive to buy privately
- time delay between interstitial and blood glucose levels
- provides large amounts of data
what is flash glucose monitoring
Abbot Freestyle Libre sensor
- 14 day sensor, scanned by a handheld reader
- partial funding support in some areas on the NHS
- doesn’t have hypo alarms
give examples of insulin pump therapy
- one touch ping insulin pump
- omnipod insulin pump
what are the advantages of insulin pumps
- avoiding insulin injections
- greater freedom and flexibility
- fewer large swings in blood glucose
- improvements in HBA1C
what are the challenges with insulin pumps
- checking blood glucose every 3-4 hours
- changing infusion site every 48-72 hours
- may take several months to optimise
what does the artificial pancreas project consist of
- insulin pump
- cannula
- glucose sensor
- transmitter
what are the challenges with the artificial pancreas project
- creating an ideal algorithm
- speed of response and insulin delivery
- production and development cost
- safety
what is the guardian sensor 3 TM technology
the 1st and only sensor approved by FDA to control a hybrid closed loop system
- 7 day continuous wear
- incorporates diagnostic technology that continuously monitors how the sensor is doing
what are islet transplants used for
- islets are in short supply- new sources of insulin producing cells required
- transplanted cells run out of steam- enhance and protect the function of transplanted cells
what is the role of B cells in response to blood glucose
- very sensitive to changes in blood glucose
- secrete active insulin in response to elevated blood glucose
outline the properties of ideal replacement B cells
- capable of expansion to useful numbers
- glucose responsive insulin secretion
- able to control proliferative capacity
- able to evade immune destruction
what can be used to generate Beta cells
- embryonic stem cells
- adult stem cells
outline the process of normal pancreatic development in producing B cells
- stem cell- can become any cell type
- pancreatic precursor- any pancreatic cell type
- pancreatic precursor- endocrine pancreas cells only
- beta cells
what are the challenges in driving human embryonic stem cells towards new B cells
- pure cell populations
- fully functional b cells
- control of growth
- safe, transplantable
outline the process of producing B cells using adult stem cells
- naive stem cell- can become any cell type
- tissue specific precursor
- adult cell
- through transdifferentiation, adult cell can become different adult cell
what are the characteristics of pancreatic stem cells
- mature beta cells have a lifespan of 50 days
- replaced by neogenesis from progenitor cells
