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154 Cards in this Set
- Front
- Back
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What are the signs of ketoacidosis? |
Abdominal pain, illness, tired, heavy breathing and smelly breath, |
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What is ketoacidosis? |
Ketones are produced when fat is broken down in the body. This is normal when you are starving and your brain needs glucose, however when produce in large amounts it causes ketoacidosis which causes the blood to go acidic. |
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What causes ketons to start accumulating? |
When you are insulin deficient and your glucose is high there is no key to the cells (insulin) which require glucose. Your body then thinks that your sugar level is low, even though its not, it just can't get into the cell. As a result of this your body starts to create ketones from the fatty acids in your cells which breaks down fat in the body which in turn release more glucose into your system. This then means your sugar is even higher making your body want to produce if more ketones which creates a vicious cycle which can lead to ketoacidosis. To combat this you must take insulin! |
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Why might your sugar go up without eating anything when ketones are present? |
The body thinks that there isn't enough glucose in the blood stream as there is know key (insulin) to let it get into the cells which makes the body break down fat to create ketones which releases more sugar into your system. |
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Why when passing urine in ketoacidosis could lead to a coma? |
Due to the excessive urination you dehydrate the body so its vital to stay hydrated in this state. |
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Ketoacidosis can develop much quicker from alcohol. And your body may need more insulin when ill. |
Read front |
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Causes of ketoacidosis? |
Missed insulin dose, stress or illness, high sugar levels, high ketone levels. |
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Why does stress increase your likelyhood of high sugar and ketoacidosis? |
Your body releases adrenaline in response which increases sugar in the blood stream. There is no insulin for this which can cause ketones to ensue. |
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Ketoacidosis and insulin deficiency over the years can lead increased insulin resistance. |
Read. |
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Ketoacidosis effects your IQ and damages your brain. For every time you are hospitilsed your IQ drops by 1. High glucose in long term decrease brain function. |
Reas |
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What is the sign of blurred vision? |
High blood glucose. |
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The brain cannot store glucose so needs a even supply. It will transfer to ketones if it doesn't have glucose. |
Read |
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Why is insulin important in the muscles and liver? |
Helps the body store glucose and glycogen in the liver and muscle. It also decreases the production of glucose from the liver. |
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Insulin increases the production of muscle protein. |
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How else can the liver produce glucose? |
Through a process called gluconeogenesis the liver can use protein and fat to make glucose. |
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What is the name of sugar stored in the liver? |
Glycogen. The average adult has 100 to 120 g stored in the liver. This will usually last an adult 24 hours. |
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What is glucagon? |
It is produced by the alpha cells in the liver and raises blood glucose from glycogen in the liver. Glucagon is used for unconscious injection. |
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Why shouldn't you eat for at least 30 minutes after being injected with glucagon? |
You may feel ill and be sick. |
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What does is mean if your sugar levels don't go back to normal after a glucagon injection? |
It means that your glycogen store has been completely depleted Eg from exercise or a recent hypo. |
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Why might you need more insulin after a heavy workout for the next 12 to 24 hours? |
Growth hormone is released which also releases my sugar. |
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What will cause glucagon to be less effective? |
If you have taken to much insulin. |
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What effects do adrenaline (stress) have on sugar levels? How is adrenaline caused? |
It raises blood sugar by breaking down glycogen stores in the liver. Adrenaline reduces the amount of glucose taken up in the cells. This happens because your body is in fight or flight mode in which the sugar is being reserved in the bloodstream for your brain. Adrenaline is cause by stress, fever and acidosis. |
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When sugar is low adrenaline is released. How and why is this? |
By adrenaline being released it brings the sugar up by using glycogen from the liver, but at the same time this adrenaline causes shakiness, anxiety and a pounding heart. Adrenaline can also stimulate the body to break down fat to fatty acids which make ketones in the liver. |
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There are two types of hypoglycaemia reactions (symptoms) what are they? |
The body Eg adrenaline released causing shakiness or neurological where speech and behaviour are affected. Neurological symptoms are usually a sign of a lower blood glucose. |
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Make sure to take your glucagon pen with you when you go away and tell friends /family how to use it. |
Read |
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Why can symptoms of hypoglycaemia change on the glucostat? |
Depending on your control will effect when you start experiencing hypoglycaemia Eg having low sugar over a long time will make you less prone to symptoms un till you get very low. This would be the opposite effect for pro longed high levels causing you to experience hypo at say 5.0. |
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What effects your ability to learn? |
Hypoglycaemia |
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Coffee has been shown to improve hypo awareness but in moderate amounts. |
Read |
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Hypoglycaemia unawareness can increase the risk of severe hypo. |
Read. |
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What is the rebound phenomenon? |
Your body after a hypo will try a counter regulation in which may be to effective and your sugar goes to high. When these counter rebound hormones are active (few hours) your body will be more insulin resistance meaning you will need to take more before your next meal. |
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Remember to take more insulin if you have had a hypo and are going to eat soon as thr rebound hormone will be active. |
Read |
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How long does the rebound phenomenon usually last? |
12 hours |
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What is the issue when taking to much insulin for the liver and how does this controlling your blood sugar? |
When you take more insulin, the more difficult it is for the liver to release its glucose stores. This means that a hypo caused by to much insulin is harder to reverse that a hypo caused by not enough food. |
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Adrenaline is less effective when asleep which may contribute to not waking up when you hypo. |
Read. |
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What causes the dawn phenomenon? |
It is caused when you wake up and your body releases growth hormone which can put your sugar up by 1.5 to 2 mmol. |
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Having a meal at night with short acting insulin puts you more at risk of dead bed syndrome. |
Read. |
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Adults with type 1 diabetes have died from hypo from drinking alcohol as it prevents the liver from producing glucose. |
Read |
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How much will 10g of sugar raise in mmol? |
Average 2 mmol in 15 minutes |
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You will put on weight if you treat a hypo with to much sugar |
Read |
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3 tablets will raise sugar by 2 mmol and 6 for 3-4 mmol |
Read |
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3g of glucose in 1 tablet |
Read |
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What food should you avoid to get the quickest response from a hypo? |
Fat should be avoided because it causes the stomach to empty slower meaning glucose reaches the bloodstream later. |
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Don't do any exercise for a least 15 mins after a hypo |
Read |
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Still take insulin after a hypo if you eat a snack (don't count the fast acting sugar) |
Read |
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If you experience a hypo just before a meal it is better to take glucose Eg tablets first to correct your sugar and then wait 15 - 20 to eat so you can give the right amount of insulin. |
Read |
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Food must reach the intestines first before glucose is released |
Read |
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Chocolate/ bars raise the sugar slowly so not recommended for hypos. |
Reas |
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If you don't have full consciousness and are still have hypo symptoms form the brain after 15 minutes of treatment it can be a sign of brain oedema which is swelling. Get hospital care immediately |
Read |
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Hypo or having one before exams can effect results to make sure to wait a couple of hours. |
Read |
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What will massaging an insulin injection do? |
It will help the insulin to take effect quicker. |
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Why should you inject insulin 15mins before your meal? |
It helps the timing of insulin with the blood sugar release from food and its very important to do this at breakfast. |
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If your sugar rises more than 4mmol after checking your sugar (2 hours) then it's a sign that you haven't taken your insulin at least 15 minutes before your meal or not enough. (only for breakfast) |
Read |
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Nova rapid will work straight away on all meals except breakfast where you must inject at least 15 mins before. |
Read |
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What does bolus means and basal injections mean? |
Bolus is what's known at the long acting/background insulin and basal is known as fast acting insulin. |
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Your body always needs to have some insulin in the body, even between meals to take care of glucose produced in the liver. |
Read |
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High blood glucose in the night can give you a bad hba1c even if you are well controlled in the day |
Read |
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Injecting insulin in the thigh before a leg workout will considerably increase insulin absorption. |
Read |
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How long should you massage the injection site to get better absorb form the the insulin? |
15-30 mins |
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What can be bad about hot changes in temperature and insulin sensitivity? |
Going from normal temperature to very hot Eg a bath or sauna can increase sensitivity by allot. Heat will increase absorption so take care in sunny locations. Did you know that taking a hot bath at 85 degrees can put your insulin sensitivity up by 110% and going from a room temperature of 20 degrees to 35 can increase it by 60%. |
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How does cold affect insulin? |
It decreases the effect |
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How long do you have to take your insulin if you forgot to take it before a meal? |
Make sure to inject the intended amount within the first hour otherwise if 2 or 3 hours have passed do a correction dose. |
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If your clubbing ams take levemir on a night reduce the amount by 2 to 4 units |
Read |
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What should I do I fi forgot to take my levemir in the morning? |
If a few hours have past then take the normal amount but I made need a little extra insulin at the next meal. If say half a day has gone then take have the amount. |
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If I wake up with high blood sugar, nausea and ketones then it's a sign of insulin deficiency. Take 0.1 units for every kg of body weight and then set an alarm and measure in 1 to 2 hours. If it hasn't changed do the same process and wait a further 2 hours. If know success then ring a doctor immediately. |
Read |
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If you take the wrong insulin at night Eg mixed up pens then it's vital that you check your sugar frequently in the night and make sure your not home alone. Check every hour or so and have carbs on hand that are fat free as fat slows the release of carbs. Reverse count carb if possible by Eg if you take 20 units of nova rapid and your ratio it 1:20 then 20units would need (20x20) 400 carbs. |
Read |
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Having a routine is vital in stabilising sugar eg waking up roughly at the same time time every morning and eating at the same times. Don't drink alcohol or go on nights out. |
Read |
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Clean hands before finger prick and avoid sugar being on fingers |
Read |
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Why shouldn't you let anyone else use your glucose device? |
Even though you may think it's safe with a new lancet, traces of blood can stay on the finger pricker causing cross contamination leading to hepatitis B. |
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What effect does high altitudes and low temperatures have on the effect on glucose reading? |
They can give unreliable low and high readings. |
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When should you check for ketones? |
ill, stressed, sick, and sugar level consistently high |
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Blood ketone tests are a lot more reliable that urine ones. |
Read |
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What causes starvation ketones? |
Unlike ketones when your cells are hungry for glucose and your insulin deficient, starvation ketones is caused when the glucose is low. The reason the cells are starving is because you haven't ate enough food and glucose for what the cells require which is common when you havent been eating enough or have been vomiting . However if you give a high dose of insulin then it will counteract the transformation of fat and fatty acids to ketones as the cells have the key. |
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Ketones without glucose in the urine indicates you didn't eat enough before goin to bed (starvation ketones) |
Read |
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At what blood ketones level should you contact your doctor or go straight to the emergency apartment? |
When they are 3.0 mmol or above |
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Ketones + high glucose level = lack of insulin Ketones + low sugar level = lack of food (carbs) |
Read |
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When treating ketones due to lack of insulin , you may need a drink high in glucose near by to prevent a hypo. The level of ketones my increase for the first hour then should start to drop. |
Read |
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Check for ketones if sugar is 13mmol or higher is not coming down after a few hours and check them in the morning or at bed if at 13mmol or higher |
Read |
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When ill with ketones why is it important to drink sugar containing fluids? |
Because your taking a high amount of insulin you need to counteract any possible hypos. |
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Insulin cannot withstand temperatures below 2 degrees and it loses its effectiveness at 25 to 30. At 35 degrees it will be inactivated four times as it is a room temperature. Don't leave it in the sun or a hot car. |
Read |
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What should you do if insulin is cloudy? |
Discard and don't use it |
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Insulin pens should not be shared as there is a risk of blood borne infections like hepatisis, even if you change the needle. |
Read |
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If insulin leaks onto skin after injection, this would roughly be 1 unit and is caused by air in the cartridge which is compress when you press the mechanism. Wait 15 seconds with the needle in the skin to counter this. |
Read |
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Never decrease the amount of food to regulate your blood sugar when ill. Drink sugar containing drinks if appetite is poor. |
Read |
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When ketones ar present do not five extra insulin more often that every 2 hours or you risk dose overlap resulting in a hypo. |
Read |
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If your sugar is really high and you feel fine it could be a sign of dehydration so drink plenty of water and if you are passing plenty of urine your sugar can drop a lot without insulin. Check for ketones for precaution. |
Read |
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If you perform a correction does near bedtime, half the amount of units for the correction dose to prevent nigh time hypo and check sugar at night. |
Read |
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If sugar is high before meals do the following drink some water before the meal as this helps the stomach empty quicker. If 8-11 mmol increase the dose by 1 or 2 units and take the insulin just before meal. 11-14 mmol 2-3 units with water, take 10 mins before. 14-20 mmol, 2-4units with water, take 20 mins before meal. 20mmol + 0.1 units for every kg of body weight, take 20 mins before and drink water. |
Read |
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What to ask yourself if your sugar level wasn't expected to be? |
To much food? Timing correct? ill? Rebound phenomenon? Injection sight different? Muscle rather than fat? Fatty lump? |
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Being hungry even when sugar is high is telling you your cells lack glucose from insulin. If you eat as normal without extra insulin and sugar remains high, this overtime will increase insulin resistance. |
Read |
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Change carb ratio by 2 g when ration is in 10 to 20 grams carbs range when adjusting ratio. |
Read |
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Don't treat a high glucose from stress or rebound phenomenon as in these situations the blood usually decreases by itself within 1 - 3hours. If your going to correct use half a dose. |
Read |
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Measure ketones before exercise if sugar is high and give half thr correction dose. |
Read |
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Increase carb ratio by 10-20% if exercise within 1 - 2 hours. When ill reduce by 10-20%. |
Read |
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The correction dose should include levemir as well. |
Read |
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Reduce insulin on a night time meal by 2-4 units after strenuous exercise |
Read |
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At around midnight to 2 am insulin sensitivity is high and can drop sugar. However if blood sugar starts to increase after midnight the insulin resistance will increase and the bed time insulin dose will not fix this. |
Read |
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Why should you make sure insulin has not gone passed its use by date or been stored properly? |
It can break down and give rise to harmful substances that can cause reactions. |
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Why is the eyes kidneys and nerves effected by high sugar? |
The cells in these organs or not dependent on insulin meaning they acn suffer from glucose toxicity. |
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Salt in the blood stream increases absorption of glucose into the blood stream. |
Read |
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Fat and fibre release glucose more slowly into the blood stream. |
Read |
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What will empty your stomach more quickly? (sugar gets into the blood stream quicker) |
Small bites, liquid food, hypo, light exercise, drink with food |
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What causes the stomach to empty more slowly (slower release of glucose)? |
Large bites, solid foods, high sugar level, heavy exercise, drink after food, fatty food, high protein, fibre, extremely hot or cold |
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Avoid all trans fats as this is bad for diabetes. Eg chocolate, pastries, cake, crisps, vegetable oils |
Read |
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Be careful of coconut oil as its not good for you as its high in saturated fat. |
Read |
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Ensure that you always weigh the cooked food rather than the dry food as the difference can be a lot and could mess your doses. Eg a past dry at 70g is 25g when cooked. |
Read |
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How do you calculate your Carb to insulin ratio? |
Divide total number of calories consumed for all meals in a day and divide by total bolus. Don't include basal. |
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You may need a high dose of insulin in the morning as your more insulin resistant compares to other meals in the day when you are not. |
Read |
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What to do if you have taken to much insulin |
Example 8.5 units taken instead of 3.5. Ratio of 20g for 1 unit. 8.5-3.5 =5. 5x20=100carbs need eating. |
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Exercise will help the insulin door stay open for longer and more glucose will be transferred to the muscles |
Read |
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After strenuous exercise lower insulin on night time meals and evening by 1to 2 units or possibly upto 4. Eat a slow carb meal |
Read |
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Insulin sensitivity after exercise can last upto 24 hours |
Read |
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Anaerobic exercise such as a sprint can release adrenaline and glucagon causing in spike in sugar but can drop significantly after exercise. Aerobic exercise (moderate) will drop sugar in exercise and after. |
Read |
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Do NOT exercise when insulin is low. |
Read |
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If you plan to exercise within 2 hours after a meal reduce the dose by 30 to 50%. If the training is longer than 90 mins you may need to reduce it more. |
Read |
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It's important to know that exercise alone will not lower blood glucose level at all. Insulin must be present. |
Read |
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If sugar is high and ketones are present, postpone exercise and take required insulin |
Read |
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Reduce basal insulin up to 10 to 20% after exercise. |
Read |
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It takes more than one meal to fill up glycogen stores in your liver. |
Read |
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Meals after exercise should be reduce by about 1 to 2 units, but don't decrease to much as the liver needs insulin to refill glycogen stores. If you have hypo problems despite dose change, eat more carbs |
Read |
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Always carry glucose tablets in your pockets! |
Read |
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Did you know that a 1% decrease in body mass due to dehydration may effect your performance. Drink 250 ml before and 200 ml every 20 mins. |
Read |
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Why should you check sugar levels before exercise? |
High levels impair your performance and it can mean your dehydrated due to increased sugar in the urine. Also high sugars reduce beta endorphins which help perform better. |
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High or low sugar can effect your reaction time and thinking in exercise. Try and start exercise at 5-6mmol and then drink something sweet every 30 mins. |
Read |
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Playing sport in warm and humid environments may also increase blood sugar because of the increase of counter regulatory hormones. |
Read |
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Glycogen stores can be enhanced with a Carn beverage roughly 1 hour before activity (1-2 carb for every Kg weight). Try get a drink with max simple sugars of 10%. |
Read |
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Heavy exercise requires 1 to 1.5 glucose for every kg of body weight and hour. Eg I weigh 68kg so I will need this in carbs for that hour. |
Read |
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Guide to pre meal reduction exercise Walking/swimming vo2 max 25% 30 mins 25%reduction, 60 mins 50% redu. 50% vo2 max running, football, 30 mins 50% redu, 60 mins 75% redu. |
Read |
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When ill and very ill you still must nourish your body with sugar and carbs taking extra insulin. |
Read |
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A cold shouldn't require extra insulin but if you have a fever then yes. |
Read |
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When to go to hospital |
Repeated vomiting, increases ketones and laboured breathing, high sugar levels despite extra insulin, severe or unusual abdominal pain, serious confusion, make sure to call first to make sure Eg 111 |
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Gastroenteritis is an infection of the intestinal tract which causes vomiting and diarrhoea resulting in low nourishment and low sugar. You will need to lower your insulin considerably (opposite to most other illnesses where you will need more). The same goes for food poisoning. This reduction can last two weeks. |
Read |
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Sugar drinks that can be given when ill- tea with sugar, fruit juice, sport drink, take sips every 15 mins when sick or vomiting. |
Read |
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Be aware that vomiting can be a sign of insulin deficiency. |
Read |
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What can lead to tooth decay? |
When your glucose levels are high, glucose can form in the salvia. |
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What to do when eating a very high fat food such as pizza? |
Your best delaying the insulin dose by 1 hour due to the fat slowly releasing the sugar and you should take a extra 1 to 3 units |
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Studies show a 25% increase in the risk of lung cancer when passive smoking Eg at work, social exposure ect |
Read |
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If you drink alcohol on the evening you will be at risk of hypo all night and partly the next day due to liver working on the alchol |
Read |
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Severe hypos from drinking have killed diabetics |
Read |
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If you have been drinking heavy (which I won't be as iv quit drinking) you need to make sure your sugar is over 10mmol before going to bed. Reduce bedtime insulin by 2 to 4 units and eat slow releasing carbs. |
Read |
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Never drive a car below 4.8 mmol. |
Read |
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Frozen insulin loses its effect. Don't leave it in a cold place eg a car when cold. When it's below freezing outside, put the insulin inside and inner pocket to keep it at a cool temperature |
Read |
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AGE (advanced glycation end products) is caused by glucose binding to organs each the eyes which causes damage. |
Read |
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What main advantage does angiosperm seeds have over the spores of lower plants such as ferns and mosses? |
They are far more durable seeds being able to stay dormant for a long time and can withstand harsh weather. |
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It's important to reduce correction dose by half at night time due to risk of hypo. |
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Having a blood glucose above 14mmol before exercise requires care. Check for ketones and if present stop. If not present take 0.05 units/kg body weight and check suagr after 30 mins. |
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Aim to exercise 1-2 hours after reduced insulin dose, otherwise you risk having a hypo. |
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Dehydration can cause high glucose due to urine being passed. |
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If you start exercise at 5 to 7 mmol without food it's important to take glucose at intervals every 30 mins. Preferably half from instant sugars and half from slow releasing. |
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Alchol blocks gluconeogenisis, so if your unconscious, a glucagon pen may not work due to the liver breaking down the alchol. |
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Anyone you know who is diabetic should know to have a blood glucose above 10mmol before bed after drinking alchol . |
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Intense exercise for 1 hour require 1g carb for every kg body weight. |
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Carrying on exercise with ketones is highly dangerous. This is becuase the body will release further sugar into the blood stream due to muscles not having glucose. The body will also release more adrenaline causing even more glucuse to be released. Insulin must be present with all forms of exercise! |
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Don't be fooled, not eating and taking any insulin can still cause sugars to rise. The body thinks the cells are starving and will release glucose from the liver. |
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If you have ketones or high sugar, a good way to increase insulins absorption rate is to massage the site for 15 minutes! |
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