Diabetes + Insulin

Question 1

Key characteristics of type 1 Diabetes

Answer 1

Autoimmune condition that Kills pancreatic beta cells

No insulin production

Ketones present - common complication is DKA

Require Insulin treatment

Question 2

Key characteristics of Type 2 Diabetes

Answer 2

Insulin resistance

Does not produce enough insulin

Diagnosed at adulthood (diet, lifestyle)

Treatment include Metformin and Insulin

Question 3

3 P’s in Diabetes

Answer 3

Polyuria: excessive peeing

Polydipsia: excessive thirst

Polyphagia: excessive hunger

Question 4

What key complements are used to Diagnose diabetes ?

Answer 4

HbA1c: >48mmol (>6.5%)

BGL: > 7mmol/L

Question 5

What is DKA?

Answer 5

Diabetic Ketoacidosis is a diabetic complication of hyperglycaemia

Not enough insulin - high BSL - reduced glucose utilisation by body - BSL continue to rise due to Gluconeogenesis and Glycogenolysis producing more glucose for hungry cells

Cells breakdown protein & fat into energy - breakdown of fat in liver produce acidic ketones - excessive ketone build up causing acidosis

Question 6

Signs and symptoms of DKA

Answer 6

Kussmaul breathing
Acetone fruity breath
Postural hypotension
Hypovolemia (fluid loss) & dehydration
SOB
Polyuria
Polydipsia
Vomiting and abdo pain

Question 7

Wha treatment is required for DKA and HHS?

Answer 7

IVT Fluid replacement 0.9% NS

Insulin therapy infusion

Potassium replacement to correct electrolyte imbalance

Hourly VBG, BSL and ketone checks

IV Glucose replacement after BSL drop below 14mmol/L

Question 8

Common presentation of DKA ?

Answer 8

High BSL >20mmol
Ketones >1
Thirsty
High RR
Tachycardic
Vomiting and not eating - did not take insulin

Question 9

What is HHS?

Answer 9

Hyperosmolar Hyperglycaemia State is a complication of Hyperglycaemia and poor management of BSL

No acidosis present !

Occur in Type 2 diabetic patients

High BSL >40mmol/L

Question 10

Symptoms of HHS?

Answer 10

High BSL
Dehydration, dry mouth and thirst (polydipsia)
Polyuria
Concentrated blood due to water loss
Altered consciousness and confusion
Blurred vision

Complication of seizure coma and death

Question 11

Symptoms and treatment of Hypoglycaemia?

Answer 11

Cold and clammy, Diaphoresis (sweating), palpitations, weak and fatigued,
Confusion, shakiness and inability to arouse

Require 15g oral intake of carbs juice soda and recheck BSL in 15min

Question 12

Insulin syringes are based on units. how many mls is 100units?

Answer 12

1ml

Question 13

What is rapid onset fast acting insulin

Answer 13

Rapid onset: start to work from 1to 20min and peak an 1 hour later

Must eat food immediately after taking insulin

Example: NovoRapid, Humalog, Apidra

Question 14

What is a Short acting Insulin?

Answer 14

They begin to lower BGL within half an hour

Must have insulin half an hour before eating

Peak effect 2-4 hours and lasting 6 to 8 hours

Example: Actrapid, Humulin R,

Question 15

What is Intermediate acting insulin?

Answer 15

Cloudy appearance

Protamine / zinc added to delay action

Insulin begins to work 1.5 hours after injection

Peak 4-12 hours lasting up to 24 hours

Example: Protaphane, Humulin NPH

Question 16

What is a mixed insulin ?

Answer 16

Cloudy appearance

Pre mixed combination of rapid acting, short acting and intermediate

30/70 - 30% rapid acting 70% intermediate acting

Example: Mixtard 30/70 and Mixtard 50/50 (both are mixed shorting acting)

Question 17

What is a long acting insulin?

Answer 17

Slow steady release of insulin throughout the day

Injected once or twice a day

Example: Glargine ( MUST NOT BE MIXED WITH OTHER INSULIN)

last up to 24 hours

Need to be supplemented with rapid insulin at meal times