Hypoglycaemia and insulin treatment in diabetes Flashcards
(26 cards)
describe T1DM
an autoimmune condition with genetic component
- profound insulin deficiency
describe T2DM
insulin resistance
impaired insulin secretion and progressive B cell damage but initially continued insulin secretion
exessive hepatic glucose output
increased counter-regulatory hormones including glucagon
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
disadvantages of basal insulin in type 2 diabetes
Doesn’t cover meals
Best used with long-acting insulin analogues which are considered expensive.
advantages of pre mixed insulin in diabetes
Both basal and prandial components in a single insulin preparation
Can cover insulin requirements through most of the day
disadvantages of pre mixed insulin in diabetes
Not physiological
Requires consistent meal and exercise pattern
Cannot separately titrate individual insulin compononents1
risk for nocturnal hypoglycaemia2,3
risk for fasting hyperglycaemia if basal component does not last long enough3
Often requires accepting higher HbA1c goal of <7.5% or ≤8% (<58 or ≤64 mmol/mol)2,3
what is considered the best treatment of T1DM
Intensive basal-bolus insulin therapy
describe insulin therapy in T2DM
a treatment approach in which basal insulin is added to oral therapy can improve glycaemic control and reduce hypoglycaemia but bolus insulin for one or two meals is often required
what are the current classification of hypoglycaemia?
level 1
level 2
level 1 classification of hypoglycaemia
Alert value
Plasma glucose <3.9 mmol/l (70 mg/dl) and no symptoms
level 2 classification of hypoglycaemia
Serious biochemical
Plasma glucose <3.0 mmol/l
(55 mg/dl)
describe non-severe symptomatic hypoglycaemia
: Patient has symptoms but can self-treat and cognitive function is mildly impaired
describe severe symptomatic hypoglycaemia
Patient has impaired cognitive function sufficient to require external help to recover (Level 3)
describe the pathophysiological effects on the brain
Cognitive dysfunction
Blackouts, seizures, comas
Psychological effects
describe the pathophysiological effects on the musculoskeletal
Falls, accidents, driving accidents
Fractures
Dislocations
describe the pathophysiological effects on the heart
Increased risk of myocardial ischaemia
Cardiac arrhythmias
describe the pathophysiological effects on the circulation
Inflammation
Blood coagulation abnormalities
Haemodynamic changes
Endothelial dysfunction
what are the autonomic common hypoglycaemia symtoms?
-Trembling
-Palpitations
-Sweating
-Anxiety
-Hunger
what are the neuroglycopenic common hypoglycaemia symtoms?
-Difficulty concentrating
-Confusion
-Weakness
-Drowsiness, dizziness
-Vision changes
-Difficulty speaking
what are the non specific common hypoglycaemia symtoms?
Nausea
Headache
what are the causes of hypoglycaemia?
Long duration of diabetes
Tight glycaemic control with repeated episodes of non severe hypoglycaemia
Increasing age
Use of drugs (prescribed, alcohol)
Sleeping
Increased physical activity
when screening for risk of severe hypoglycaemia- what do you look for?
Low HbA1c; high pre-treatment HbA1c in T2DM
Long duration of diabetes
A history of previous hypoglycaemia
Impaired awareness of hypoglycaemia (IAH)*
Recent episodes of severe hypoglycaemia
Daily insulin dosage >0.85 U/kg/day
Physically active (e.g. athlete)
Impaired renal and/or liver function
describe patient education used to prevent hypoglycaemia?
Discuss hypoglycaemia risk factors and treatment with patients on insulin or sulphonylureas
Educate patients and caregivers on how to recognize and treat hypoglycaemia
Instruct patients to report hypoepisodes to their doctor/educator
what strategies are used to prevent hypoglycaemia?
patient education
Consider enrolling patients with frequent hypoglycaemiain a blood glucose awareness training programme
