Pathophysiology & Insulin Therapy Flashcards
Which tests should be performed if a person is presenting with symptoms of diabetes?
- OGTT
- Random BG test
- Fasting BG test
What does the c-peptide link in an insulin molecule?
It links the alpha & beta chains of the insulin molecule.
What can c peptide measurements in the urine tell us?
How much insulin secretion there is in the body.
What are the steps of treatment for a type 2 diabetic?
- Diet & exercise
- Oral monotherapy
- Oral combination
- Insulin + oral agents
What happens when a diabetic patient goes into ketosis, on a cellular level?
When they have a lack of insulin, adipose tissue breaks down, as glucose cannot be up-taken by cells.
This produces fatty acids which break down into ketones, leaving the blood more acidic.
What are insulin analogues?
They are altered amino acid sequences of normal insulin.
What is the benefit of using an insulin analogue?
You can change the duration of action for each analogue (rapid, intermediate, slow)
What is an example of a short-acting insulin?
Actrapid.
What are some examples of medium-long acting insulins?
Insulatard
Ultratard
Humulin I
What are some examples of mixed insulins?
Mixtard 30/70
Humulin M3
What are some examples of rapid-acting analogues?
Novorapid
Humalog
Apidra
What are some examples of long-acting analogue mixtures?
Lantus
Levemir
Tresiba
What are some examples of analogue mixtures (biphasic)?
Humalog mix 25, or mix 30
Novomix 30
What type of therapy is used for type 1 diabetics?
Basal-bolus therapy
Why are stronger concentrations of insulin sometimes used?
To inject a small volume.
When are rapid-acting analogues given?
5-15mins before a meal
When are basal or intermediate insulins given?
A set time everyday.
Which layer of the skin do smaller needles penetrate into?
The subcutaneous layer
What is lipohypertrophy?
Lumps of fat or scar tissue formed due to the patient not rotating their sites of injection.
How do insulin (CSII) pumps work?
CSII: continuous subcutaneous insulin infusion
A pump reservoir holds 2-3 days worth of insulin inside it.
A cannula is inserted into the skin to deliver this insulin.
The pump then delivers either a basal or set rate of insulin.
What are the benefits of using a BG sensor?
- Allows continuous BG monitoring
- Alarms can be set to avoid hypos/hypers
- BG can be measured any minute
- Health care professional can access sensor information & see any patterns
How is DKA treated?
- IV fluids to restore dehydration
- Set insulin infusion rate to restore BG (only for type 1, not type 2)
- K+ supplement
In what 2 bodily fluids can ketones be measured in?
Blood & urine.
What are the potential differential diagnosis for DKA?
- Alcohol abuse
- Starvation
- Chronic renal failure
- Lactic acidosis
- Drug toxicity
What 2 treatments do hypos occur in more?
- Insulin therapy
2. Sulphonylureas
What is hypo-unawareness?
When the patient is asymptomatic of their hypoglycaemia (can be dangerous)
What are some common causes of developing a hypo?
- Missed/delayed meals
- Overdose/misestimating insulin dose
- Weight loss
- Poor injection technique
- Renal/hepatic impairment
- Increased physical activity
What are some symptoms of hypoglycaemia?
- Shaking
- Sweating
- Hunger
- Weakness/fatigue
- Impaired vision
How do you treat a hypo?
Give a sugary drink + a long-acting carbohydrate
