Type 1 diabetes Flashcards
what is the advice from the DVLA regarding patients with diabetes + driving
- all drivers taking insulin (long term) must inform DVLA
- measure blood glucose before driving + every 2 hrs during driving
- Blood-glucose should always be above 5 mmol/litre while driving
- always have a supply of a fast-acting carbohydrate (sugary snack) in car
- if signs of hypoglycemia occur, stop car, have a snack + wait 45 mins before driving again
why should patients with diabetes only drink alcohol in moderation + when accompanied by food
Alcohol can make the signs of hypoglycaemia less clear, and can cause delayed hypoglycaemia
what does the HbA1c tell you
average plasma glucose over the previous 2 to 3 months and provides a good indicator of glycaemic control
- also a reliable predictor of microvascular and macrovascular complications and mortality (lower HbA1c = lower risk of complications/mortality)
- note: HbA1c test can be performed at any time of the day and does not require any special preparation such as fasting *
when might an oral glucose tolerance test be used
- to establish gestational diabetes
- In patients who have less severe symptoms and a blood-glucose concentration that does not establish or exclude diabetes (e.g. impaired fasting glycaemia)
note: An oral glucose tolerance test involves measuring the blood-glucose concentration after fasting, and then 2 hours after drinking a standard anhydrous glucose drink
what causes type 1 diabetes
the insulin-producing beta-cells (in the pancreatic islets of Langerhan) are destroyed which means the body produces little/no insulin
lack of insulin = hyperglycaemia
what are the symptoms of diabetes
- increased thirst
- increased urination
- sudden unexplained weight loss
- increased vaginal infections
- sexual problems
- wounds that won’t heal
- numbing/ tingling in hands or feet
- blurred vision
what is the target HbA1c for patients with type 1 diabetes
48 mmol/mol or lower
what treatment do all patients with type 1 diabetes need
insulin
describe Multiple daily injection basal-bolus insulin regimens in type 1 diabetes
- one or more injections of an intermediate/long acting insulin throughout the day as the basal insulin. then injections of short-acting insulin before meals
describe the Mixed (biphasic) insulin regimen
a mixture of short-acting insulin + intermediate acting insulin.
The insulin preparations may be mixed by the patient at the time of injection, or a premixed product can be used.
describe the Continuous subcutaneous insulin infusion (insulin pump)
regular or continuous amount of insulin (usually in the form of a rapid-acting insulin analogue or soluble insulin), delivered by a programmable pump and insulin storage reservoir
- insulin pumped through subcutaneous needle or cannula
what is the first line insulin treatment choice in type 1 diabetes
multiple daily injection basal-bolus insulin regimen.
using:
- Twice-daily insulin detemir (Levemir) should be offered as the long-acting basal insulin therapy.
- Short acting insulin also used before meals, examples
insulin aspart (Novorapid, Fiasp), insulin lispro (Humalog), Insulin glulisine
if Levemir not tolerated, can give Once-daily insulin glargine (Lantus/ Toujeo /Abasaglar)
- note: a twice-daily mixed insulin regimen should be considered if first line not possible*
when is Continuous subcutaneous insulin infusion (insulin pump) therapy used
should only be offered to patients who suffer disabling hypoglycaemia or who have high HbA1c concentrations (69 mmol/mol [8.5%] or above) with multiple daily injection therapy
what can affect the blood glucose of a diabetic
- food
- exercise
- infection
- stress
- accidental or surgical trauma (increases insulin required)
- renal or hepatic impairment (decreases insulin required)
- endocrine disorders e.g addison’s disease (decreases insulin required)
- pregnancy (increases insulin required)
note insulin/ antidiabetics may need to be adjusted in these occur
name some examples of intermediate-acting insulins
isophane insulin + biphasic isophane insulin
Humulin, Insulatard
name some examples of short-acting insulins
- insulin aspart (Novorapid, Fiasp)
- insulin lispro (Humalog)
- Insulin glulisine
name some examples of long-acting insulins
names start with: LLTT
insulin detemir insulin degludec (can be combined with liraglutide) insulin glargine (can be combined with lixisenatide)
(Levemir, Lantus, Toujeo, Tresiba)
name examples of biphasic (pre-mixed) inuslins
biphasic insulin aspart
biphasic insulin lispro
(Novomix, Humulin M3, Humalog Mix)
what causes diabetic ketoacidosis (more common in type 1 diabetes)
- when insulin levels become dangerously low, this causes glucose levels to rise (hyperglycaemia). The body can no longer use glucose effectively, so the body starts using fat as an energy source. This causes ketones to be released which make the blood acidic.
acidic blood causes symptoms of diabetic ketoacidosis (DKA)
what are the symptoms of diabetic ketoacidosis
- rapid weight loss
- nausea or vomiting
- abdominal pain
- fast and deep breathing
- sleepiness
- a sweet smell to the breath (like pears)
- a sweet or metallic taste in the mouth
- different odour to urine or sweat
note DKA most commonly occurs in type 1 diabetics but can also occur in type 2 diabetes (more commonly in patients taking SGLT2 inhibitors)
what are the 2 classes of short-acting insulins
short-acting insulins made up of:
- Soluble insulin (can be given I.V, S/C, I.M)
- rapid-acting insulin (e.g Novorapid, Fiasp, Humalog)
what is the most common use for soluble insulins
soluble insulin given (via I.V) in diabetic emergencies e.g. diabetic ketoacidosis and perioperatively
- can also be given before meals
note: when soluble insulin is given I.V the results are instant (within a few mins). when soluble insulin is given S/C it takes 30-60 mins
why is it important NOT to extract insulin from insulin pen devices
If insulin extracted from a pen or cartridge is of a higher strength, it can lead to a significant and potentially fatal overdose
how do you prevent insulin overdose (based in insulin device use)
The words ‘unit’ or ‘international units’ should not be abbreviated.
Specific insulin administration devices should always be used to measure insulin i.e. insulin syringes and pens.
Insulin should not be withdrawn from an insulin pen or pen refill and then administered using a syringe and needle.
why should patients make sure they rotate injection sites when using insulin
- to prevent deposits of amyloid protein under the skin (cutaneous amyloidosis)
- to prevent lipodystrophy (fatty deposits at injection sites)
why should diabetics not inject into lumpy areas of skin
may reduce the effectiveness of insulin
if patients change from injecting into lumpy areas, to unaffected areas, this may cause hypoglycaemia
what is the target fasting blood glucose
4–7 mmol/litre before meals at other times of the day
what is the target blood glucose after meals
5–9 mmol/litre at least 90 minutes after eating
