1 Diabetes L1 Flashcards Preview

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Flashcards in 1 Diabetes L1 Deck (40):
1

What causes T1 diabetes?

Autoimmune destruction of pancreatic B-cells.
(Idiopathic - theories about viruses/animal products)

2

Aetiology of T1

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

3

Stages of T2

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

4

90% of diabetes is T1/T2?

T2

5

Ethnicities more affected by T1?
T2?

T1 - European
T2 - Asian and afriacan-caribean

6

Difference between DKA and HHS?

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

7

Diagnostic:
HbA1c for diagnosis
Fasting
2hr post glucose load

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

8

What are the units for
HbA1c?
Blood gluc

mmol/mol
mmol/L

9

Problems with treating diabetes?

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

10

How often is diabetes reviewed?
What is screened? (4)

Annually
Retinal
Nephropathy
Hypertension
Clinical examination for vascular disease

11

Problem with repeated hypos?

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

12

Aim of insulin therapy

to replicate what happens in people without diabetes

13

Recommended targets
Fasting
2 hour post meal
HbA1c
Urine

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

14

Indications for insulin use:

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

15

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

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

16

Insulin degludec advantage/disadvantage

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

17

How does insulin degludec work?

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

18

Isophane insulin is ....... acting

Intermediate acing

19

Basal bolus involves how many injections daily?

4
(1 long acting, 3 rapid)

20

Isophane insuline disadvantage compared to long acting insulins?

risk of nocturnal hypos

21

BASAL BOLUS:
When is the rapid insulin administered?

After eating - allow flexibility with that we eat

22

What regime is good if you don't like injections

Premixed insulin, once, twice or three times daily

23

PREMIXED INSULIN REGIME
Each injection contains

Basal component
Short-acting component

24

PREMIXED INSULIN REGIME
possible regimes? (3)

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

25

PREMIXED INSULIN REGIME
Advantage for raised BMI?

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

26

Insulins in order of action

Shortest
Fast acting analogues
Soluble
Isophane
Detemir
Glargine

27

Most common regiemes:

basal bolus
and
biphasic analogue mix

28

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

Long acting insulin (insulatard, glargine, levemir)

administer at same time each day

can be given in combo with OHA

29

REGIMES
Twice daily regime is ...

Disadvantage:

Short acting component controlling rise after eating breakfast and dinner

Snacks are needed to prevent hypos

30

REGIMES
Twice daily regime is divide into

2/3 in the morning
1/3 eveing

31

What regime do we want most patients to be on?

Basal bolus

32

REGIMES
Basal bolus is

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

33

Carb counting ratio

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

34

Factors of influence in insulin (3)

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

35

What size needle should be used?

4mm

36

How does weight affect insulin requirements?

drops as you lose weight

37

How does illness affect insulin levels?

BG usually rises during illness

38

How does climate affect insulin?

More rapidly absorbed in hot weather

39

Needle advice (2)

don't reuse
don't go through clothes

40

What happens in a night hypo?

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