Flashcards in Monitoring of Diabetes Deck (19)
Which complications were shown to be massively decreased in the DCCT?
Clinical neuropathy 60%
Massive reduction in microvascular
but increased risk of significant hypoglycaemia
How is HbA1c formed?
Formed by non-enzymatic glycation of haemoglobin on exposure to glucose
Which factors may influence HbA1C?
Up/down with Hemoglobin variants
Down with Hemolytic anemia, acute or chronic blood loss, pregnancy
HbA1c level to diagnose diabetes
HbA1c ≥48mmol/mol (6.5%)
Healthy target level for HbA1c
53mmol/mol (approx 40% have >75mmol/mol)
What might you give in adjunct to glucose metre in T1DM?
What do ketone metres do?
Adjunct to glucose meter in T1DM
Measures levels of 3βOH-butyrate
Identifies early stages of ketone body formation
Identifies ‘insulin deficiency’
Allows preventative action to avoid ketoacidosis
Simple and clear ‘rules’
How could you identify early stage of ketone body formation?
With a ketone metre
…….may first complain of hunger, or more often of a sense of weakness or fatigue and, especially if it his first reaction, he is conscious of anxiety, or of what he calls nervousness….. Almost constantly present is a feeling of tremulousness……..almost always a profuse sweat
Symtpoms of hypoglycaemia
Fast heart rate (remember you've got loads of adrenaline)
What classes as severe hypoglycaemia?
Hypoglycaemia that leads to seizures, unconsciousness or the need for external assistance
15 grams of simple carbohydrate commonly used
glucose tablets (follow package instructions)
gel tube (follow package instructions)
2 tablespoons of raisins
4 ounces (1/2 cup) of juice or regular coca-cola (not diet)
1 tablespoon sugar, honey, or corn syrup
8 ounces of nonfat or 1% milk
Hard sweets, jellybeans, or gumdrops (see package to determine how many to consume)
Immediate treatment of hypoglycaemia
Consume 15-20 grams of glucose or simple carbohydrates
Recheck your blood glucose after 15 minutes
If hypoglycemia continues, repeat.
Once blood glucose returns to normal, eat a small snack if your next planned meal or snack is more than an hour or two away
Treatment of severe hypoglycaemia
Glucagon 1 mg
Inject into buttock / arm or thigh
When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting
Impaired hypoglycaemia Awareness
When hypoglycaemia occurs (4.0-3.5 mmol/l) and individuals feel no or a change symptoms.
Impaired Hypoglycemia Awareness occurs more frequently in those who:
frequently have low blood glucose episodes
Long duration type 1 or 2 diabetes
Intensively-treated type 1 diabetes (low HbA1c)
What is the risk of intensely-treated type 1 diabetes (low HbA1c)
Impaired hypoglycaemia awarness
What has led to the improvement of glycemic control?
Frequent blood glucose testing
Basal-bolus insulin regimes
Rapid acting insulin analogues
Long acting insulin analogues
Structured education available for diabetics in Tayside to help prevent hypoglycemia