Flashcards in 1 Diabetes Workshop Deck (22):
How do glargine and detemir slow absorbtion?
Glargine - micropercipitate around injection sight
Detemir - reversibly binds to albumin
With what regime to you need to adjust the insulin according to carb amount?
Multiple daily dose.
(With fixed dose regimes carbs should be spread throughout the day)
What is DKA?
Lack of insulin leads to hyperglycaemia, ketosis and metabolic acidosis.
The body burns fat instead of sugar producing ketones.
Thirst , polyuria, confusion, fatigue and nausea
Treatment outline for DKA
Fluids (excessive urination loosing glucose and water)
Insulin (to suppress ketone production)
Potassium (as insulins causes glucose and k to go into cells)
Fluids: use isotonic saline, when plasma gluc has fallen use glucose containing fluid (as a substrate for insulin and to avoid hypo)
Levels indicating DKA
BG > 11mmol/l
Urine positive for ketones or blood high in ketones
Should diabetic eat on the morning of surgery
No - omit breakfast, insulin and oral hypoglycaemic
(I think this is just the short acting insulins, you would have had a long acting the night before)
When to stop IV insulin after surgery
Switch to normal when patient starts to eat . Stop IV 30 mins after the first sub cut injection
Sick day rules if you vomit
Must be stopped with antiemetics
Sick day rules, keep taking.... And ....
Fluids and insulin (may need to be increased)
Sip sugary drinks
What is in VRii?
Insulin and dextrose to avoid hypo.
What happens in severe hypo?
Inadequate supply of glucose to the brain
How to distinguish between DKA and hypo
DKA - nausea and vom, dry skin, fruity breath, rapid breathing, drowsiness
Hypo - sweating, tachy, confusion, personality change, seizures
Less than 3.5mmol/L
Why not monitor urine in type one 3
Time frame is inaccurate, can only detect high levels (
Would you use a dip stick in type two?
Probably one - we are more interested in long term so hba1c . Might use a dip stick to check if there is a problem
Contrast biphasic and
MDI - more flexible, more accurate copy of troughs.
Basal bolus - fewer injections, no need to inject at school
Young person blood pressure targets
4-8 before meals, under 10 after
Things you could do to improve insulin control 6
Change to MDI
Check injection site and technique
Increase insulin dose
Encourage self monitoring
Exercise and weight loss to reduce need
Guidline for increasing insulin dose
2 units or 10% adjustment
For rapid acting this can be daily,
For long acting every 3 days
Name some long term complications of diabetes
Micro vascular like neuropathy, retinopathy
Macrovascular like MI, stroke, vascular disease