Hypoglycemia And Insulin Treatment In Diabetes 07.12.23

Question 1

What are the insulin therapies used in diabetes

Answer 1

Basal insulin and rapid acting analogues

Question 2

How do the differences between T1DM and T2DM require a different approach to insulin therapy

Answer 2

Type 1

Autoimmune condition (β-cell damage) with genetic component
Profound insulin deficiency

Type 2

Insulin resistance
Impaired insulin secretion and progressive β-cell damage but initially continued insulin secretion
Excessive hepatic glucose output
Increased counter-regulatory hormones including glucagon
On the background of excessive energy intake

Question 3

What is modern insulin therapy in type 1 diabetes

Answer 3

Separation of basal from bolus insulin to mimic physiology

Pre-meal rapid acting boluses adjusted according to pre-meal glucose and carbohydrate content of food to cover meals

Basal insulin should control blood glucose in between meals and particularly during the night

Basal insulin given as either twice daily insulin levemir (basal analogue or once daily degludec) adjusted to maintain fasting blood glucose between 4–7 mmol/L

Question 4

Once-daily basal insulin (insulin medication) is given for type 1, type 2 diabetes or both?

Answer 4

Only in type 2

Question 5

Twice-daily mix insulin (insulin medication) is given for type 1, type 2 diabetes or both?

Answer 5

Both type of diabetes

Question 6

Basal-bolus therapy insulin (insulin medication) is given for type 1, type 2 diabetes or both?

Answer 6

Mainly used in type 1 diabetes, sometimes used in type 2

Question 7

Advantages of basal insulin in type 2

Answer 7

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

Question 8

Disdvantages of basal insulin in type 2

Answer 8

Doesn’t cover meals
Best used with long-acting insulin analogues which are considered expensive.

Question 9

What organ systems does hypoglycaemia have pathophysiological effects on?

Answer 9

Brain (Cognitive dysfunction
Blackouts, seizures, comas
Psychological effects), musculoskeletal (Falls, accidents, driving accidents Fractures Dislocations), heart (Increased risk of myocardial ischaemia
Cardiac arrhythmias), circulation (Inflammation
Blood coagulation abnormalities
Haemodynamic changes
Endothelial dysfunction)

Question 10

What are common autonomic, neuroglycopenic and non-specific symptoms of hypoglycaemia?

Answer 10

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Question 11

What are causes of hypoglycaemia?

Answer 11

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

Question 12

What are the screening factors for severe hypoglycaemia?

Answer 12

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

Question 13

What is the treatment for hypoglycaemia?

Answer 13

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