Diabetes Inspidus, DVLA,Diagnostic Tests And Type 1 Diabetes Flashcards
(18 cards)
Make a note of these things that always get asked
-side effects of insulin
-safe prescribing
- awareness and common errors with prescribing and how they can be prevented
- sick day rules and intercurrent illness
- monitoring and effectiveness of the insulin regimen
- appropriate advice and Shen to use different regimens
- different types and devices
- moas and sides effects
What causes diabetes and what are the different types?
- diabetes is either caused by insulin deficiency or by the resistance to insulins action
- type 1 is the most common
- others - gestational, secondary diabetes (pancreatic or hepatic cirrhosis)
What is diabetes insipidus
Nothing to do with sugar
- its then the body can no longer control water properly, a result of the a decreases amount of the hormone ADH - antidiuretic hormone
- kidneys can’t hold enough water
- key symptoms would be passing urine - dehydration and so patients become very thirsty
- there are 2 types of= cranial or nephrogenic
- cranial = brain producing less antidiuretic hormone - treat with vasopressin
- nephrogenic - kidneys resistant to effects of ADH, do not hold water - carbamazepine,thiazide diuretic - paradoxical effect,oxytocin
Side effect of desmopressin (cranial)
Extreme dilution of water = hyponatraemia convulsions
What is the DVLA advice for diabetics?
Chance of hypoglycaemia - lead to comas
All drivers treated with insulins must inform DVLA
Drivers must notify DVLA depending on their treatment, license type and whether or not the have diabetic complications eg.episodes of hypoglycaemia
- drugs with greatest risk of hypoglycaemia = insulins,suphonylres,meglitinides
What is the DVLA advice?
- Avoid hypoglycaemia and know warning signs and action to take
- Carry a glucose meter and test strips whilst you are driving
- Check blood glucose no more than 2 hours before driving and every 2 hours whilst driving
- blood glucose should always be less than 5 mmol/l while driving
- take a snack if blood glucose falls to or below 5mmol/l (FIVE and Drive)
- always ensure fast acting glucose with you in the car
- do not drive if blood glucose is less than 4 mol or there are warning signs of hypoglycaemia
- if already driving the, stop vehicle in safe place, switch engine off, eat or drink suitable source of sugar, wait until 45 mins after blood glucose is normal before continuing journey
- don’t drive if hypoglycaemia awareness is lost and notify DVLA
-RESUME driving when medical reports show hypoglycaemia awareness awareness has been regained
Advice on alcohol and diabetes?
Don’t have to stop, but with food as it can mask hypoglycaemia. All done in moderation and with food
Hypo symptoms - increased heartbeat, confusion and hunger
OGGT - oral glucose tolerance test
How well you can tolerate glucose
- Diagnoses impaired glucose tolerance
- establish gestational diabetes
- involves measuring blood glucose concentration after fasting for 8 hrs and the 2 hrs after drinking a standard anhydrous glucose drink
HB1AC testing
- Diagnose type 2 diabetes and not type 1
- Gylcated haemoglobin (Hb1Ac) forms when red blood cells are exposed to glucose
- Hb1Ac reflects average plasma glucose over previous 2-3 months
- good induction for glycemic control
- performed at anytime of the day unlike OGTT test and doses don’t require special considerations like fasting etc
- Previously % but now mmol/mol
Uses of HB1AC
- monitoring glycemic control in type 1 and 2
- diagnosing type 2 diabetes but not type 1
When not to use HB1AC
- type 1 diagnosis
- children diagnosis
- pregnant women - up to 2 months postpartum
- do not use in the following - diabetes symptoms for less than 2 months, high diabetes risk and acutely ill, treatment with medication that causes hyperglycaemia, pancreatic damage, HIV and chronic disease)
What’s the best thing about HB1AC
It is a reliable predictor of microvascular and macrovascular complications and mortality
- lower values associated with lower risk of short term vascular complications
- individualised HbA1c targets are recommended
- monitor type 1 patients every 3-6 months (more frequently if blood glucose changing rapidly)
- monitor type 2 patients every 3-6 months until medication and HbA1c are stable then monitor every 6 months
Important points about testing
Hb1AC and fasting blood glucose = type 2 diabetes
OGTT= Gestational diabetes
Random blood glucose test = type 1
Hb1Ac =RBC+Haemoglobin + glucose. RBC last in body for about 3 months so Hb1Ac reflects control over 3 months
Type 1 diabetes is defined by what?
It’s an absolute insulin deficiency - due to little or no insulin secretion due to destruction of insulin producing beta cells in the pancreatic islets of langerhans
It is an autoimmune condition which occurs at anytime stage but mainly childhood
Diabetic complications will occur if hyperglycaemia is poorly managed
What are the diabetic complications?
- retinopathy
- nephropathy
- neuropathy
- premature CVD
- peripheral arterial disease
Signs and symptoms of type 1
- increased thirst
- frequent urination especially at night
- hyperglycaemia (random plasma conc more than 11 mmol/ml)
- extreme hunger
- unintended weight loss
- irritability and other mood changes
- fatigue and weakness
- blurred vision
Aims of treatment of type 1
- use insulin regimens to achieve optimal glucose levels
- avoid or reduce hypoglycaemic episodes
- minimise risk of long term macro and microvascular complications
- prevent disability from complications by early detection and active management of disease
- the target for glycaemic control should be individualised for each patient
