6: Monitoring of diabetes and hypoglycaemia

Question 1

Why is glycaemic control important in people with diabetes?

Answer 1

Better glycaemic control reduces your risk of microvascular complications

Question 2

What are the three main microvascular complications of diabetes?

Answer 2

Neuropathy

Nephropathy

Retinopathy

Question 3

An HbA1c level of 7% is equal to what in units?

Answer 3

53 mmol/mol

Question 4

What are the main macrovascular complications of diabetes?

Answer 4

CVD

MI

Stroke

Question 5

How do you explain HbA1c to a patient?

Answer 5

“Glycated haemoglobin”

i.e glucose sticking to your red blood cells, gives an indication of your blood sugar levels and therefore how well your diabetes is controlled

Question 6

HbA1c indicates your average blood glucose level over a period of how long?

Answer 6

1.5 - 2 months

Question 7

A normal (i.e non-diabetic) HbA1c level is less than __ mmol/mol.

Answer 7

42 mmol/mol

Question 8

In pre-diabetes, HbA1c is between __ and __ mmol/mol.

Answer 8

42 and 47 mmol/mol

Question 9

In uncontrolled diabetes, your HbA1c level is more than __ mmol/mol.

Answer 9

48 mmol/mol

Question 10

Really poorly controlled diabetes is indicated by an HbA1c level of more than __ mmol/mol.

Answer 10

75 mmol/mol

Question 11

What is a limitation of HbA1c?

Answer 11

Gives an average

so a person with wildly fluctuating hypers and hypos will have the same average as someone with an consistently elevated blood glucose level

Question 12

Which type of insulin is preferred for treating T1 DM?

Answer 12

Analogue insulin

Question 13

How is blood glucose most commonly monitored at the moment?

Answer 13

Pin prick test

Question 14

What is the new development in glucose monitoring intended to replace pin prick testing?

Answer 14

Continuous glucose monitoring

Question 15

How can you view the results of continuous glucose monitoring devices?

Answer 15

Computer

Phone (yours and others)

Question 16

Pin prick testing measures ___ glucose.

Continuous glucose monitoring and flash monitoring measures ___ glucose.

Answer 16

Pin prick - blood glucose

Continuous / flash - interstitial glucose

Question 17

The range of values for blood and interstitial glucose are different.

Which is more useful?

Answer 17

Interstitial glucose

Question 18

What is a possible side effect of insulin overdose or sulphonylurea therapy?

Answer 18

Hypoglycaemia

Question 19

What is the alert value for blood glucose concentration in hypoglycaemia?

Answer 19

4 mmol/mol

Question 20

What are some symptoms of hypoglycaemia?

Answer 20

Tremor

Sweating

Anxiety

Dizziness

Hunger

Tachycardia…

Impaired vision, weakness, aggression…

Question 21

What is the definition of severe hypoglycaemia?

Answer 21

Seizures

Unconsciousness

Inability to manage blood glucose yourself

Question 22

Apart from insulin and glucagon, which other hormones are important in controlling blood glucose concentration?

Answer 22

Cortisol

Adrenaline

Growth hormone

Question 23

Secretion of hormones controlling blood glucose concentration are controlled in what rhythm?

Answer 23

Circadian rhythm

Question 24

Which pancreatic endocrinopathy causes hypoglycaemia?

Answer 24

Insulinoma

Question 25

In people with Type 1 diabetes, the blood glucose threshold at which alpha cells produce glucagon **(increases / decreases)**.

Answer 25

**decreases**

Question 26

Aggressive treatment to prevent hypoglycaemia causes ___ and increases your risk of \_\_\_.

Answer 26

**hyperglycaemia** **microvascular complications**

Question 27

When does hypoglycaemia usually occur?

Answer 27

**At night**

Question 28

What is the rough dosage of insulin per kg?

Answer 28

**0.5 units / kg**

Question 29

A high HbA1c is a marker of someone who doesn't ___ with their insulin regime.

Answer 29

**comply**

Question 30

What is impaired hypoglycaemia awareness?

Answer 30

**Hypoglycaemia where the patient doesn't recognise the symptoms**

Question 31

Impaired hypoglycaemia awareness commonly occurs in which groups of patients?

Answer 31

**Patients who:** a) frequently have hypos b) have had diabetes for a long time c) Type 1 diabetics who are being intensively treated

Question 32

Why is hypoglycaemia a vicious cycle?

Answer 32

**Sets threshold for symptoms lower each time, meaning you're more likely to be hypoglycaemic more often, setting the threshold lower...**

Question 33

Why does recurrent hypoglycaemia increase your tolerance for hypoglycaemia?

Answer 33

**Preconditioning** cellular make-up changes in response to new state

Question 34

Tolerance to hypoglycaemia in Type 1 diabetes occurs in the state of **(hyper/hypoglucagonaemia)**.

Answer 34

**hyperglucagonaemia**

Question 35

What is habituation?

Answer 35

**Reduced response to a stimulus as a result of repeated/prolonged exposure** e.g reduced response to hypoglycaemia

Question 36

How is hypoglycaemia treated?

Answer 36

**If conscious**: 15-20g carbohydrate, recheck condition in 15 minutes **If unconscious:** IV glucagon +/- IV insulin afterwards

Question 37

What are some of the most common causes of hypoglycaemia?

Answer 37

**Insulin overdose** **Sulphonylurea overdose**

Question 38

What disease, causing adrenal insufficiency, can cause hypoglycaemia?

Answer 38

Addison's disease