Mechanisms and consequences of hypoglycaemia, and pharmacology of insulin treatment options in type 1 diabetes Flashcards
What are the key features of type 1 diabetes mellitus?
- Autoimmune condition (β-cell damage) with genetic component
- Profound insulin deficiency
What are the key features of type 2 diabetes mellitus?
- Insulin resistance
- Impaired insulin secretion and β-cell damage but initially continued insulin secretion progressive
- Excessive hepatic glucose output
- Increased counter-regulatory hormones including glucagon
Do T1DM or T2DM require insulin?
T1DM
Eventually T2DM will need insulin
Which type of diabetes is once-daily basal insulin used in?
Only type 2
Which type of diabetes is twice-daily mix insulin used in?
Both
Which type of diabetes is basal-bolus therapy used in?
Mostly in type 1
Sometimes in type 2
What are the advantages of basal insulin in type 2 diabetes?
- Simple for the patient, adjusts insulin themselves, based on fasting glucose measurements
- Carries on with oral therapy, combination therapy is common
- Less risk of hypoglycaemia at night
What are the disadvantages of basal insulin in type 2 diabetes?
- Doesn’t cover meals
- Best used with long-acting insulin analogues which are considered expensive
What are the advantages of pre-mixed insulin?
- Both basal and prandial (meal) components in a single insulin preparation
- Can cover insulin requirements through most of the day
What are the disadvantages of pre-mixed insulin?
- Not physiological
- Requires consistent meal and exercise pattern
- Cannot separately titrate individual insulin components
- Increased risk for nocturnal hypoglycaemia
- Increased risk for fasting hyperglycaemia if basal component does not last long enough
- Often requires accepting higher HbA1c goal of <7.5% or ≤8% (<58 or ≤64 mmol/mol)
Which is considered the best treatment for T1DM?
Intensive basal-bolus insulin therapy
What HbA1c levels do many people start insulin at?
levels of ≥9%
What is level 1 hypoglycaemia?
- Alert value
- Plasma glucose <3.9 mmol/l (70 mg/dl) and no symptoms
What is level 2 hypoglycaemia?
- Serious biochemical
- Plasma glucose <3.0 mmol/l (55 mg/dl)
What is non severe hypoglycaemia?
Patient has symptoms but can self-treat and cognitive function is mildly impaired