what is type one diabetes got nothing to do with
Lifestyle or diet
what happens and type one diabetes
Your body attacks, the insulin cells in the pancreas
So you can’t produce any insulin at all
your body still breaks down food and carbohydrates and turns it into glucose. But when the glucose enters the bloodstream, there is no insulin to allow it to do so. more and more glucose builds up in your bloodstream.
what does insulin do?
It allows the glucose in our blood to enter our cells and fuel our bodies
what are the symptoms of type one diabetes?
Well, before diagnosis your body tries to get rid of the glucose through the kidneys. makes you wee a lot
extreme thirst
feel very tired
to get enough energy, the body will break down, fat stores to provide fuel. why people often lose weight.
What treatment is there for type one diabetes
get insulin through injection or pump
check blog glucose isn’t too high or low
what percent of people with diabetes have type two
90%
what happens and type two diabetes
Your pancreas cannot work properly or your pancreas, can’t to make enough insulin
what happens to blood glucose levels and type two diabetes
Blood glucose levels, keep rising
What can happen to the pancreas and type two diabetes
It can get tired and stop producing insulin or reduce the amount of insulin produced. This further increases the levels of blood glucose.
what are the symptoms of type two diabetes?
Feeling very tired because the body cannot get enough glue close to the cells
needing to wee
cuts and grades
infections
thirsty
how long can people live with type two diabetes before being diagnosed in some cases?
10 years
what can high glucose levels in your blood seriously damage?
Your heart
your eyes
your feet
complications of diabetes
how can you treat type 2 diabetes
healthy eating
Being more active
losing weight
eventually, people will need medication to bring their blood glucose down to a safe level
- What are Ms Lupin’s risk factors for diabetes?
South Asian descent
Age
Overweight
Family history of diabetes
Poor diet consisting of take-aways and fast food (contributes to weight gain)
Alcohol
How does metformin reduce blood sugar?
Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilisation.
Why is Metformin the first line agent for type 2 diabetes?
Metformin is first line because it has good data to support a reduction in HbA1c, has a positive effect on weight loss, does not cause hypos, and is recommended by NICE guidelines.
- What could be causing Ms Lupin’s stomach ache?
Metformin is known to cause gastrointestinal intolerance resulting in symptoms such as stomach cramps. In the SPC, gastrointestinal disorders are listed as “very common.”
What would you recommend given the information Ms Lupin has told you?
To prevent the side effect, it is recommended that metformin be taken in 2 or 3 daily doses during or after meals. A slow increase of the dose may also improve gastrointestinal tolerability (extract from SPC)
However, her poor adherence needs to be considered in any advice given as she states she hasn’t been taking this regularly with BD dosing and is due to increase. She has also been on a slower titration than BNF dosing
BNF information states GI side effects often resolve spontaneously – encourage patient to persevere
Could try MR preparation but no evidence of benefit
MHRA’s advice about Metformin – Vit B12 deficiency
. Why is it important that Ms Lupin has an eye examination?
Diabetes affects your eyes when your blood glucose, is too high. In the short term, you are not likely to have vision loss from high blood glucose. People sometimes have blurry vision for a few days or weeks when they are changing their diabetes care plan or medicines. Retinopathy screening ensures that this microvascular complication can be monitored to ensure early intervention and prevent long-term damage
- Are there any other routine checks or tests that would be advised for Ms Lupin?
Blood Pressure
Cholesterol check
QRISK score – predicting risk of CV event in the next 10 years
ACR (Albumin to Creatinine Ratio) to check for nephropathy
Creatinine to check for DKD (CrCl < 60 mL/min)
Foot examination
- Which of Mrs Pettigrew’s presenting signs and symptoms are typical of DKA?
Polyuria
- Polydipsia
- Being sick
- Tummy pain
- Kussmauls breaths increasing metabolic acidosis (blood pH changes).
- Lethargy
- Confusion/passing out/unconsciousness
- Breath that smells fruity (like pear drop sweets or nail varnish)
what is DKA
DKA stands for Diabetic Ketoacidosis, which is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. It typically happens when there is a severe lack of insulin in the body, leading to a buildup of glucose (sugar) in the bloodstream. Without enough insulin, the body’s cells cannot use glucose for energy, so they start breaking down fat for fuel instead. This process produces ketones, which can make the blood acidic and cause various symptoms and complications.
- What do you think is the most likely cause of Mrs Pettigrew’s condition?
Self-neglect
* Eating? and if so what (diet has a big effect on blood glucose levels)
* Incorrect Injection technique – Is she administering the correct dose of insulin?
* Check injection sites (hyperlipotrophy)
* Storage of insulin? (is in in date?)
- A nurse is unsure which insulin to use for IV infusion. Which one of the
following would you recommend and why?
Actrapid® – because it is recommended in Joint British Diabetes Society (JBDS) guidelines and also because short acting insulin last up to 2 hours therefore wouldn’t degrade prior to entering the blood stream.
