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Dietetics written exam > Diabetes > Flashcards

Diabetes Flashcards

(56 cards)

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1
Q

Types (4)

A

Type 1
Type 2
LADA
MODY

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2
Q

Type 1

A

Absolute insulin deficiency due to beta-cell destruction

No/little C-peptide

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3
Q

C-peptide

A

Marker of insulin production

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4
Q

Type 2

A

Relative deficiency or insensitivity to insulin

Use c-peptide volume for when to start insulin

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5
Q

LADA

A

Latent autoimmune diabetes in adults
Gradual onset of diabetes
Similar to Type 2

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6
Q

MODY

A

Mature onset diabetes of the young

Gene mutation

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7
Q

Consequences (6)

A 
CVD
Amputation
Pregnancy complications
Depression
Retinopathy
Neuropathy
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8
Q

DCCT study

Good control

A

Slows onset + progression of eye, kidney + nerve damage

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9
Q

Insulin

A

Take when CHO >10g
Work with individual so regimen suits lifestyle
Anabolic
Progressive weight gain problem when glycaemic control tightened

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10
Q

Insulin

Groups

A

Animal
Analogues
Human (synthetic)

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11
Q

Insulin

Storage

A 
Check expiry
Keep stock in fridge
Discard if out of fridge >28d
Never freeze
Away from heat
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12
Q

Insulin

Rapid acting analogues

A

2-5hrs
Children
Before/with or after food

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13
Q

Insulin

Mixed analogues

A

Medium insulin + rapid analogue

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14
Q

Insulin

Long-acting ANALOGUE

A

Once day
Background
Same time each day

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15
Q

Insulin

Short-acting

A

Humulin
15-30min before meal
Peak 2-6hr

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16
Q

Insulin

Medium-acting

A

Humulin I

20-30min before meal or bedtime

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17
Q

Insulin

Long-acting

A

Levemir
1 or 2 x/day
Background insulin

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18
Q

Injecting

A 
MDI
New needle each time
Under skin (not muscle)
Rotation sites to avoid lipohypertrophy
Stomach, buttocks, thighs
Don’t inject area if going to use (e.g. run)
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19
Q

Closed loop system:

CSII

A

Continuous subcutaneous insulin infusion

Pump therapy

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20
Q

Closed loop system:

Current pumps

A

Last 5y
Basal can be changed
Add insulin for food eaten
Check BG levels regularly

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21
Q

Closed loop system:

CGM

A

Continuous glucose monitor
Printout 24hr glucose levels
20min behind finger prick test

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22
Q

Closed loop system:

Cannula

A

Should be straight
Insert with device/needle
Change 2-4d

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23
Q

Other methods taking insulin

Study These Flashcards
A

Inhaling - don’t know how much taken
Patches - insulin molecule too large
Tablets - broken down in stomach

Islet transplantation - still experimental

24
Q

Diagnostic criteria
HbA1c
Fasting BG
Random glucose

Study These Flashcards
A

HbA1c >48mmol/mol
Fasting BG >7mmol/L
Random glucose >11.1mmol/L

Repeat test required for confirmation

25
Adjusting insulin | Twice daily
Morning insulin affects dinner time BG | Evening insulin affects morning BG
26
Adjusting insulin: | Long-acting analogue
Long time to adjust | Titrated up 2 units every 3d
27
Adjusting insulin: | Rapid acting
Flexible | Adjusted by testing before + 2hr after meal
28
Self BG testing
Finger prick test Subtle changes not always felt Accurate picture of BG levels T1: 4x/d (before meals, before bed) Tips - no soap, side of finger, rotate fingers, warm hands
29
HbA1c
Measure of BG over past 3m Target - Adults <48 and children <59 Higher = more glucose in circulation rather than going into cells
30
Hypoglycaemia
When BG <4mmol/L Unpleasant but not long term harm Prevent with regular BG testing
31
Hypoglycaemia | Treatment
15-20g quick acting CHO - 5 jelly babies - 1/2 can coke
32
Hypoglycaemia: | Symptoms
``` Headache Sweating Weakness Confusion (All caused by increased adrenaline) ```
33
Hypoglycaemia | If continues to fall
Brain function impaired (drunk like behaviour) | Eventually may become unconscious
34
Hyperglycaemia
>7mmol/L (fasting) Symptoms >11mmol/L Can damage internal organs if long period time
35
Hyperglycaemia | Causes
Stress Illness High CHO consumption Missing insulin
36
Hyperglycaemia | Symptoms
Increased - thirst - hunger - urination
37
Ketoacidosis
Risk if BG >15mmol/L Lack glucose so energy source switch to FA => ketone bodies High ketone = severe illness Detect ketones with finger prick test
38
Ketoacidosis | Causes
Too little insulin | Miss meal
39
Ketoacidosis | Symptoms
``` N+V Blurred vision Pear drop smell Dehydration Coma ```
40
Gastroperesis Definition... Insulin... S+S...
Delayed gastric emptying Nerves to stomach damaged/not working High BG damages vagus nerve (controls movement) Adds to difficulty of BG control Insulin - eat then take, take more as smaller regular meals S+S - N+V, weight loss, reflux, abdo bloating, decrease appetite
41
Exercise
Always test BG beforehand - If <4 CHO snack + wait 15min - if >15 test for ketones Don’t exercise if feeling unwell Runsweet website for advice
42
Ramadan
Muslim religious fast | Exemption if have diabetes
43
Illness
``` More insulin, fluid + testing Test BG + ketone Non-sugary fluid 100-200ml/hr Continue to eat normal If unable to eat solids - Ribena, Milk, Cola ```
44
Aims of treatment | Adults
Insulin regimen to match routine/lifestyle | Need to know - patterns, exercise, preferences
45
Aims of treatment | Children
``` Prevent/treat complications CV protection Appropriate growth Whole family Weight management Psychological - CAMHS Centile + BMI charts Adolescents - fads, alcohol, peer pressure ```
46
Secondary causes
``` Pancreatic disease Endocrine disease IBD Insulin-receptor abnormalities Genetic syndromes ```
47
Enteral feeding
More basal insulin or insulin drip Hyper common in hospitalised patients May not be on normal insulin regimen Optimise feed + ensure insulin there
48
Cystic fibrosis
Prevalence CFRD increases with age of survival Features T1 + T2 Regular screening Insulin = treatment Diet - CF > DM so adjust insulin to fit / high energy, fat + planned refined CHO
49
Coeliac disease
``` Most cases T1DM diagnosed before CD Diagnosis - IgA blood test or biopsy Symptoms vary between individuals GF diet Complications - growth failure, malabsorption, recurrent hyp ```
50
NICE (2)
Low GI foods not recommended for BG control | Weight management advice if clinically indicated
51
SIGN 2017 (3)
Smoking cessation Alcohol <14u/wk Structured education for those having hypo or failing to achieve glycaemic targets
52
Diabetes UK recommendations | CHO
Main consideration for glycaemic control Amount + type affect BG levels
53
Diabetes UK recommendations | MDI + CSII
Benefit from adjusting insulin to CHO intake
54
Diabetes UK recommendations | Fixed insulin regimen
Should consume consistent CHO quantities day-to-day
55
Diabetes UK recommendations | Fibre
30g/d as with general population
56
Diabetes UK recommendations | P.A
General health benefits but no evidence it benefits glycaemic control

Dietetics written exam (48 decks)

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