6: Monitoring of diabetes and hypoglycaemia Flashcards Preview

Endocrine Week 2 2017/18 > 6: Monitoring of diabetes and hypoglycaemia > Flashcards

Flashcards in 6: Monitoring of diabetes and hypoglycaemia Deck (38)
Loading flashcards...
1
Q

Why is glycaemic control important in people with diabetes?

A

Better glycaemic control reduces your risk of microvascular complications

2
Q

What are the three main microvascular complications of diabetes?

A

Neuropathy

Nephropathy

Retinopathy

3
Q

An HbA1c level of 7% is equal to what in units?

A

53 mmol/mol

4
Q

What are the main macrovascular complications of diabetes?

A

CVD

MI

Stroke

5
Q

How do you explain HbA1c to a patient?

A

“Glycated haemoglobin”

i.e glucose sticking to your red blood cells, gives an indication of your blood sugar levels and therefore how well your diabetes is controlled

6
Q

HbA1c indicates your average blood glucose level over a period of how long?

A

1.5 - 2 months

7
Q

A normal (i.e non-diabetic) HbA1c level is less than __ mmol/mol.

A

42 mmol/mol

8
Q

In pre-diabetes, HbA1c is between __ and __ mmol/mol.

A

42 and 47 mmol/mol

9
Q

In uncontrolled diabetes, your HbA1c level is more than __ mmol/mol.

A

48 mmol/mol

10
Q

Really poorly controlled diabetes is indicated by an HbA1c level of more than __ mmol/mol.

A

75 mmol/mol

11
Q

What is a limitation of HbA1c?

A

Gives an average

so a person with wildly fluctuating hypers and hypos will have the same average as someone with an consistently elevated blood glucose level

12
Q

Which type of insulin is preferred for treating T1 DM?

A

Analogue insulin

13
Q

How is blood glucose most commonly monitored at the moment?

A

Pin prick test

14
Q

What is the new development in glucose monitoring intended to replace pin prick testing?

A

Continuous glucose monitoring

15
Q

How can you view the results of continuous glucose monitoring devices?

A

Computer

Phone (yours and others)

16
Q

Pin prick testing measures ___ glucose.

Continuous glucose monitoring and flash monitoring measures ___ glucose.

A

Pin prick - blood glucose

Continuous / flash - interstitial glucose

17
Q

The range of values for blood and interstitial glucose are different.

Which is more useful?

A

Interstitial glucose

18
Q

What is a possible side effect of insulin overdose or sulphonylurea therapy?

A

Hypoglycaemia

19
Q

What is the alert value for blood glucose concentration in hypoglycaemia?

A

4 mmol/mol

20
Q

What are some symptoms of hypoglycaemia?

A

Tremor

Sweating

Anxiety

Dizziness

Hunger

Tachycardia…

Impaired vision, weakness, aggression…

21
Q

What is the definition of severe hypoglycaemia?

A

Seizures

Unconsciousness

Inability to manage blood glucose yourself

22
Q

Apart from insulin and glucagon, which other hormones are important in controlling blood glucose concentration?

A

Cortisol

Adrenaline

Growth hormone

23
Q

Secretion of hormones controlling blood glucose concentration are controlled in what rhythm?

A

Circadian rhythm

24
Q

Which pancreatic endocrinopathy causes hypoglycaemia?

A

Insulinoma

25
Q

In people with Type 1 diabetes, the blood glucose threshold at which alpha cells produce glucagon (increases / decreases).

A

decreases

26
Q

Aggressive treatment to prevent hypoglycaemia causes ___ and increases your risk of ___.

A

hyperglycaemia

microvascular complications

27
Q

When does hypoglycaemia usually occur?

A

At night

28
Q

What is the rough dosage of insulin per kg?

A

0.5 units / kg

29
Q

A high HbA1c is a marker of someone who doesn’t ___ with their insulin regime.

A

comply

30
Q

What is impaired hypoglycaemia awareness?

A

Hypoglycaemia where the patient doesn’t recognise the symptoms

31
Q

Impaired hypoglycaemia awareness commonly occurs in which groups of patients?

A

Patients who:

a) frequently have hypos
b) have had diabetes for a long time
c) Type 1 diabetics who are being intensively treated

32
Q

Why is hypoglycaemia a vicious cycle?

A

Sets threshold for symptoms lower each time, meaning you’re more likely to be hypoglycaemic more often, setting the threshold lower…

33
Q

Why does recurrent hypoglycaemia increase your tolerance for hypoglycaemia?

A

Preconditioning

cellular make-up changes in response to new state

34
Q

Tolerance to hypoglycaemia in Type 1 diabetes occurs in the state of (hyper/hypoglucagonaemia).

A

hyperglucagonaemia

35
Q

What is habituation?

A

Reduced response to a stimulus as a result of repeated/prolonged exposure

e.g reduced response to hypoglycaemia

36
Q

How is hypoglycaemia treated?

A

If conscious: 15-20g carbohydrate, recheck condition in 15 minutes

If unconscious: IV glucagon

+/- IV insulin afterwards

37
Q

What are some of the most common causes of hypoglycaemia?

A

Insulin overdose

Sulphonylurea overdose

38
Q

What disease, causing adrenal insufficiency, can cause hypoglycaemia?

A

Addison’s disease