1 Diabetes L1

Question 1

What causes T1 diabetes?

Answer 1

Autoimmune destruction of pancreatic B-cells.

Idiopathic - theories about viruses/animal products

Question 2

Aetiology of T1

Answer 2

Could be either. Reduced insulin secretion
or 
hyperinsulinemia and insulin resistance
or
reduction in insulin recptors

Question 3

Stages of T2

Answer 3

1 hyperinsulineaemia - body compensates for insulin resistance by increasing insulin secretion
2 hyperglycemia - as resistance increases and b-cells fail to compensate glucose levels rise
3 T2 escalating b-cell failure and loss of hypoglycemic control

Question 4

90% of diabetes is T1/T2?

Answer 4

T2

Question 5

Ethnicities more affected by T1?

T2?

Answer 5

T1 - European

T2 - Asian and afriacan-caribean

Question 6

Difference between DKA and HHS?

Answer 6

Diabetic ketoascidosis (T1)
Hyperosmolar hyperglycaemic state (T2) is like DKA withour the ketones

Question 7

Diagnostic:
HbA1c for diagnosis
Fasting
2hr post glucose load

Answer 7

>/= 48mmol/mol
>/= 7mmol/L
>/= 11mmol/L

Question 8

What are the units for
HbA1c?
Blood gluc

Answer 8

mmol/mol

mmol/L

Question 9

Problems with treating diabetes?

Answer 9

Diabetes and complications are often silent - treatment may cause more symptom than disease.

Question 10

How often is diabetes reviewed?

What is screened? (4)

Answer 10

Annually 
Retinal
Nephropathy
Hypertension
Clinical examination for vascular disease

Question 11

Problem with repeated hypos?

Answer 11

Your body stops warning you so eventually there is only a few minutes from being fine to being unconcious

Question 12

Aim of insulin therapy

Answer 12

to replicate what happens in people without diabetes

Question 13

Recommended targets
Fasting
2 hour post meal
HbA1c
Urine

Answer 13

Fasting 4-7mmol/L
2 hour post meal <8.5mmol/L
HbA1c 48-58mmol/mol
Urine: negative

Question 14

Indications for insulin use:

Answer 14

Type 1
Poor controlled type 2
Intercurrent illness (pre/post op, infection, MI, steroid therapy)
Pregnancy (if uncontrolled)

Question 15

Once daily basal insulin - advantage of modern basal insulins (lantus and levimir)?

Answer 15

less risk of hypo in the night as levels are stable - 24h cover

Question 16

Insulin degludec advantage/disadvantage

Answer 16

Expensive
vs
od ultra long acting and flat profile (reduced risk of nocturnal hypo)

Question 17

How does insulin degludec work?

Answer 17

Forms soluble hexamers at injection site - monomers gradually separate and absorb

Question 18

Isophane insulin is ……. acting

Answer 18

Intermediate acing

Question 19

Basal bolus involves how many injections daily?

Answer 19

4

1 long acting, 3 rapid

Question 20

Isophane insuline disadvantage compared to long acting insulins?

Answer 20

risk of nocturnal hypos

Question 21

BASAL BOLUS:

When is the rapid insulin administered?

Answer 21

After eating - allow flexibility with that we eat

Question 22

What regime is good if you don’t like injections

Answer 22

Premixed insulin, once, twice or three times daily

Question 23

PREMIXED INSULIN REGIME

Each injection contains

Answer 23

Basal component

Short-acting component

Question 24

PREMIXED INSULIN REGIME

possible regimes? (3)

Answer 24

1. Once daily with largest meal
2. Twice daily with breakfast and dinner
3. Three times daily with each meal
   DO NOT GIVE AT BED TIME

Question 25

PREMIXED INSULIN REGIME | Advantage for raised BMI?

Answer 25

You can have three doses with meals (encouraged not to have afternoon snack)

Question 26

Insulins in order of action

Answer 26

``` Shortest Fast acting analogues Soluble Isophane Detemir Glargine ```

Question 27

Most common regiemes:

Answer 27

basal bolus and biphasic analogue mix

Question 28

REGIMES Once daily insulin regime is ........ must be administered.... and can be given with....

Answer 28

Long acting insulin (insulatard, glargine, levemir) administer at same time each day can be given in combo with OHA

Question 29

REGIMES Twice daily regime is ... Disadvantage:

Answer 29

Short acting component controlling rise after eating breakfast and dinner Snacks are needed to prevent hypos

Question 30

REGIMES | Twice daily regime is divide into

Answer 30

2/3 in the morning | 1/3 eveing

Question 31

What regime do we want most patients to be on?

Answer 31

Basal bolus

Question 32

REGIMES | Basal bolus is

Answer 32

Long acting at the same time each day (usually bed) | Short acting just before meals (adjusted to exercise, carb count, BG)

Question 33

Carb counting ratio

Answer 33

1unit for 10g carbs | but you initially need to adjust to patterns to obtain a baseline

Question 34

Factors of influence in insulin (3)

Answer 34

- length of needle - absorption from injection site - time of injection (crucial in hospital)

Question 35

What size needle should be used?

Answer 35

4mm

Question 36

How does weight affect insulin requirements?

Answer 36

drops as you lose weight

Question 37

How does illness affect insulin levels?

Answer 37

BG usually rises during illness

Question 38

How does climate affect insulin?

Answer 38

More rapidly absorbed in hot weather

Question 39

Needle advice (2)

Answer 39

don't reuse | don't go through clothes

Question 40

What happens in a night hypo?

Answer 40

Cortisole raises sugar when you wake so it looks like you need to increase your insulin dose