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Flashcards in 1 Diabetes Workshop Deck (22):
1

How do glargine and detemir slow absorbtion?

Glargine - micropercipitate around injection sight
Detemir - reversibly binds to albumin

2

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)

3

What is DKA?

Lack of insulin leads to hyperglycaemia, ketosis and metabolic acidosis.
The body burns fat instead of sugar producing ketones.

4

Symptoms

Thirst , polyuria, confusion, fatigue and nausea

5

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)

6

Levels indicating DKA

BG > 11mmol/l
Urine positive for ketones or blood high in ketones
Acidosis (pH

7

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)

8

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

9

Sick day rules if you vomit

Must be stopped with antiemetics

10

Sick day rules, keep taking.... And ....

Fluids and insulin (may need to be increased)
Sip sugary drinks

11

What is in VRii?

Insulin and dextrose to avoid hypo.
Hourly obvs

12

What happens in severe hypo?

Inadequate supply of glucose to the brain

13

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

14

Hypo level

Less than 3.5mmol/L

15

Why not monitor urine in type one 3

Time frame is inaccurate, can only detect high levels (

16

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

17

Contrast biphasic and
mdi

MDI - more flexible, more accurate copy of troughs.
Basal bolus - fewer injections, no need to inject at school

18

Young person blood pressure targets

4-8 before meals, under 10 after

19

Things you could do to improve insulin control 6

Change to MDI
Check complience
Check injection site and technique
Increase insulin dose
Encourage self monitoring
Exercise and weight loss to reduce need

20

Guidline for increasing insulin dose

2 units or 10% adjustment
For rapid acting this can be daily,
For long acting every 3 days

21

Name some long term complications of diabetes

Micro vascular like neuropathy, retinopathy
Macrovascular like MI, stroke, vascular disease

22

Why are analogues more rapidly absorbed than soluble?

Analogues remain as monomers
Soluble becomes he oner and must dissociate to be absorbed.