Type 1 Diabetes Flashcards
What is diabetes?
A disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood
What is pre-diabetes?
Glucose levels above normal, but not (yet) diagnostic
What is T1D?
Cannot produce insulin.
Characterised by autoimmune destruction of the pancreatic B-cells
What is T2D?
Resistant to insulin / cannot produce enough insulin
What is gestational diabetes?
Problems with glucose metabolism during pregnancy. Onset or during the second or third trimester
What is GAD?
An antigen that triggers antibodies to attack pancreatic cells.
What is T1D incidence in all diabetes cases?
5-10%
What is often the first presentation?
Diabetic Ketoacidosis (DKA)
What are some risk factors for the development of diabetes?
Overweight
Waist size
Age
Family history
Sedentary lifestyle
Diet
Gestational diabetes
PCOS
Sleep disorder
Smoking
Race
What are some complications?
Heart disease
Nephropathy
Neuropathy
Peripheral vascular disease
Retinopathy
Stroke
What organs are affected by micro-vascular complications?
Eye
Kidney
Neuropathy
What organs are affected by macro-vascular complications?
Brain
Heart
Extremities
How to prevent complications?
Keeping blood glucose levels as close to normal as possible slows the onset and progression of the eye, kidney and nerve damage cause by diabetes.
What is DAFNE?
Dose Adjustment fo Normal Eating (management strategy for T1D)
What are the ideal blood glucose levels?
- Before breakfast: 5.0 – 7.0 mmol/L
- Before other meals: 4.0 – 7.0 mmol/ L
- Before bed: 5.0 – 9.0 mmol/L
Keeping your average glucose within the target helps you to:
- feel well
- avoid minor infections caused by above target range glucose
- avoid severe hypos
- avoid DKA (diabetic ketoacidosis)
- prevent, delay or slow down progression of the long-term
complications - ensure a healthy baby (for women planning a pregnancy).
What strategies helps in the management of glucose levels?
Keeping a diary can help:
* Date: record date/ time of tests
* Time: glucose reading, eating,
insulin, exercise
* CP: Carbohydrate portion
* BG: Blood glucose level
* QA: Quick acting insulin taken
* BI: Basal insulin taken (once/twice per day)
What is the goal of DAFNE?
To mimic ‘non-diabetic’ insulin production
Explain Basal insulin
~1 unit/ hr (varies, not dependent on CHO intake)
* Standardise time of delivery (once/ twice per day – min 7 hr gap)
* Dawn phenomenon: BG from 3 am until waking (hormones)
* Optimal = glucose constant (within 1-2 mmol/L) during night/periods with no CHO
Explain quick acting (insulin):
Use before food, reactive to CHO intakes
- Units of QA: units of CHO (CP’s) = QA ratio
- Use to prevent/ stop ketone production
- Trial and improvement process
Correct ‘out of range’ readings
- 1 unit QA ↓ glucose by 2.0 – 3.0 mmol/l.
- 1 CP (10g CHO) glucose by 2.0 – 3.0 mmol/l.
- Assume a change of 3.0 mmol/l to begin with.
- Do not adjust by more than 4 units QA (irrespective of BG).
- CGM? Use the arrow direction.
- Do not correct ‘above target’ before bed (risk of nocturnal hypo).
- Mild hypo: do not correct glucose readings in the first meal.
- Severe hypo: do not correct BG for at least 24 hours.
- Do not correct between meals (insulin stacking – can cause hypoglycaemia).
- Correction needed: illness; 3 hours post-meal if BG > 13 mmol/L/ CGM trend,
insulin sensitivity decreases when BG high. - Regular corrections: Ratios may need correcting. Note in diary using +/
In DAFNE stepwise approach, what is the meaning of POP?
- P: Identify the problem
- O: Exclude other causes
- P: Is there any pattern?
In DAFNE stepwise approach, what is the meaning of IDOL?
- I: Which insulin is responsible?
-D: What dose change is required?
-O: Observe the results by continued monitoring
-L: Leave it 48 hours (except nigh-time hypos) to wait for a pattern
What are the optimal glucose management goals?
- No severe hypos (needing help from others).
- No more than three weekly hypo alerts (BG 3.5 mmol/L – 3.9 mmol/L).
- Achieving the recommended times in range (CGM user)
- 70% glucose in range (3.9 to 10.0 mmol/L)
- < 4% between 3.0 mmol/L to 3.8 mmol/L
- < 1% below 3 mmol/L
- Less variability in glucose levels (< 36%).
- Hypo aware (glucose level < 3.5 mmol/L).
- No DKA.
- Stable body weight.
- Flexible lifestyle.
- Good quality of life
