diabetes management

Question 1

what are the targets in diabetes management? (1)

Answer 1

preprandial -4-6mmol/L
bedtime 6-8mmol/L
reduce risk from associated diseases

Question 2

what does education involve? (1)

Answer 2

managing, health issues, complication avoidance

Question 3

describe basal-bolus regime

Answer 3

one single injection per day
long lasting
background for whole day to prevent ketoacidosis
& at meal times

Question 4

describe split-mixed regime

Answer 4

fewer injections

usually external care

Question 5

what healthy living advice is given? (1)

Answer 5

personalised diabetes management plan
dietary advice
lifestyle interventions where appropriate

Question 6

what blood glucose management advice is given? (1)

Answer 6

explain targets and the need to maintain them

Question 7

what nutrition is advised in type 1?

Answer 7

less then 10% cals from saturated fat
glycaemic index of foods compared with standard
carb counting

Question 8

what type of exercise is advised? (1)

Answer 8

planned

Question 9

how should monitoring be used? (1)

Answer 9

previous insulin dose determines plasma glucose

initially need regular checks until px familiar with response to food

Question 10

what new insulin monitoring options are available?

Answer 10

continuous glucose monitoring

closed loop glucose monitoring

Question 11

how is type 2 managed?

Answer 11

lifestyle
weight loss
diet restriction
-avoid refined CHO
-encourage high fibre food
-reduce sat. fat
medication
surgery
-gastric band

Question 12

what medication can be used in type 2?

Answer 12

metformin- biguanide
-enhance cell insulin sensitivity
-reduce hepatic gluconeogensis
DDP-4 inhibitors
-block enzyme metabolising incretin
-improves insulin response to glucose
-reduces liver gluconeogenesis
-delays stomach emptying
GLP-1 mimetics
-increase level of incretin
sulphonylureas
-increase pancreatic insulin secretion
-can cause hypoglycaemia

Question 13

what are the acute complications?

Answer 13

hypoglycaemia
-type 1
-type 2 on sulphonylurea/insulin
insulin w/o food

Question 14

what are the chronic complications?

Answer 14

cardiovascular risk
infection risk
neuropathy

Question 15

what are diabetic eye complications?

Answer 15

cateracts
maculopathy
proliferatice retinopathy

Question 16

what are some possible diabetic neuropahys?

Answer 16

general sensation
motor neuropathy
-weakness/wasting of muscles
autonomic regulation
-awareness of hypoglycaemic lost
postural reflexes
bladder & bowel dysfunction

Question 17

why is surgery complicated in type 1?

Answer 17

fasting is a proble,
-need insulin to prevent ketosis
-need carbs to prevent hypoglycaemia
metabolic changes associated w/ surgery
-hormone changes eg adrenaline, cortisol, GH

Question 18

what are dental aspects?

Answer 18

food intake may be disrupted
acute emergencies
diabetic complications
infection risk
poor wound healing