4.0 & 4.1 Hyperglycaemia and Hypoglycaemia Flashcards Preview

Ambulance Study Notes > 4.0 & 4.1 Hyperglycaemia and Hypoglycaemia > Flashcards

Flashcards in 4.0 & 4.1 Hyperglycaemia and Hypoglycaemia Deck (69):
1

What are the signs and symptoms of hypoglycaemia?

Rapid onset of altered mental status
appear intoxicated
anxious, restless aggressive
seizure activity
abnormal behaviour
Tachycardia (thumping heart)
Pale
Cool, moist skin
Hunger
Bruising at insulin site
BSL < 3.5 mmol

2

What are some other conditions (comorbidities) that diabetic patients can have, as well as diabetes?

Ischaemic heart disease
Peripheral vascular disease
Renal impairment

3

What are some associated health risks for patients with diabetes?

infection
silent myorcardial infarction
metabolic/electrolyte disorder

4

What is the St John threshold for hypoglycaemia?

3.5mmol/l

5

What is the acceptable range for BSL according to St John?

3.5 - 7.0 mmol

6

Do you use a patients own glucose meter to measure BSL?

No

7

What is hypoglycaemia?

Low blood sugar

8

What type of diabetic patients normally get hypoglycaemic?

Those taking insulin or oral hypoglycaemics.

9

What should you suspect if a patient taking oral hypoglycemics develops hypoglycaemia?

Possible kidney failure.

Oral hypoglycemics are excreted primarily by the kidneys. This can lead to deterioration in kidney function.

10

What are some other causes of hypoglycaemia? Hint nothing to do with exercise or a missed meal.

septic shock (particularly in children)
poisoning with agents that lower glucose
liver failure

11

If you have a conscious patient with a BSL < 3.5 mmol - what is your initial treatment?

Oral glucose to recover BSL.

12

What is your treatment for a patient with hypoglycaemia,an altered LOC and cannot swallow?

patient requires IV access for glucose
or
if not able to get IV access give IM Glucagon.

13

If a patient has had a hypoglycaemic episode and suddenly becomes hyperglycaemic - what is your plan as an ambulance officer?

Instruct patient NOT to treat with insulin.
Transport patient to hospital.

14

Name some examples of alternative sugars to give to a hypoglycaemic patient?

jelly beans (5)
non diet jam (3 teaspoons)
non diet soft drink (1/2 can)
juice box

15

Name some examples of complex carbohydrates?

peanut butter sandwich
cheese sandwich

16

Why don't you give a simple carbohydrate to a patient once you have treated them for hypoglycaemia?

Because they are too quickly absorbed and another hypoglycemic event may occur.

17

What is hyperglycaemia?

High blood sugar.

Higher than 20 mmol according to St John guidelines.

18

What are the criteria for a patient who has had a hyoglycaemic episode to NOT need referral to hospital?

1. Isolated single episode
2. Clear and easily treatable cause
3. Not due to overdose of insulin or oral hypoglycaemics
4. not complicated by seizure or injury
5. Fully recover and mobilse
6. BGL is greater than 3.5mmmol/l after 10 minutes
7. Have a complex carbohydrate
8. Check BGL every hour for 4 hours
9. Adult stay with them for 4 hours
10. See GP to review treatment

19

Name the clinically significant signs and symptoms of diabetic ketoacidosis? Hint there are 5

BSL > 20 mmol
hypovolaemia from excessive
tachyponoea and general unwellness
fruity smell to breath
occasionally non specific abdo pain

20

What is osmotic diuresis?

Excessive urination caused by the presence of substances in the small tubes of the kidneys.

Glucose enters the tubes because it is being excreted and cannot be reabsorbed; this causes an increase in osmotic pressure in tubule and this causes rentention of water in the lumen; this reduces reabsorption of water and increases urine output.

21

Can a patient become hyperglycaemic after being treated for hypoglycaemia?

Yes

Must be instructed NOT to treat with insulin


22

If you have a patient with high BSL, but they do not have DKA and are just generally unwell - can you refer them to their GP for treatment?

No - it is advisable to transport to hospital.

Have a low tolerance for GP referral for any diabetic patients that are unwell.

23

What are the criteria that a patient must meet so t they do not need to immediately see a doctor if they have been treated for hypoglycaemia?

There are 10:
isolated single episode AND
not due to an overdose of insulin or oral hypoclycaemia AND
not complicated by a seizure or injury AND
they fully recover and can safely mobilise AND
their BSL is > 3.5 mmol ten or more minutes after their last glucose administration AND
they are given a complex carbohydrate AND
they have an adult they can stay with for the next four hours AND
they are instructed to measure their glucose hourly for the next four hours AND
they are instructed to see their GP to review their treatment.

24

What causes diabetic ketoacidosis and is this more comomon in type one or type two?

Cause is relative lack of insulin.

Common in Type one diabetics.

25

What does DKA stand for?

Diabetic Ketoacidosis.

26

What is diabetic ketoacidosis?

Where BSL is excessively high AND insulin level is extremely low/absent?

Dehydration occurs due to excessive urination/vomiting as glucose is excreted in the urine.
AND
Fat is metabolised for energy (produces ketones/acidosis) creating an acidic environment.

27

What are the signs and symptoms of someone who has DKA?

excessive urination
excessive hunger
excessive thirst
poor skin turgor
tachycardia
rapid, deep respirations
fruity, acetone breath
high BSL
altered LOC due to dehydration
muscle cramps
abdominal cramps
warm, dry, flushed skin
coma (very late)

28

Can type two diabetics develop diabetic ketoacidosis?

Not generally - but they can develop significant hyperglycaemia without acidosis.

29

What is glucagon used for?

The treatment of hypoglycaemia when a patient:
cannot swallow glucose AND
when IV access cannot be obtained

30

Name the clinically significant signs and symptoms of diabetic ketoacidosis?

BGL > 20mmol/L
Hypovolaemia from excessive urination and reduced oral intake and vomiting
Generally unwell
Tachyponoea
Fruity Smell to breath (Acetone)
Non specific abdo pain

31

What is the mechanism of action of glucagon?

Increases the blood sugar level by stimulating glycogenolysis.

This causes stored glycogen to be broken down into glucose - predominantly in the liver.

32

What are the contraindications for glucagon?

None

33

If you have a patient with a high BGL and just generally unwell would you refer them to their GP or transport to hospital?

Transport to hospital - have a low tolerance for GP referrals for unwell diabetic patients.

34

What is the onset of effect of glucagon?

Onset is 5 - 10 minutes (depends on absorption)

35

What is the treatment plan for diabetic ketoacidosis?

Primary and secondary survey
BGL
Backup for fluids (R51 for fluids)
Transport to hospital

36

How long does glucagon last?

10 - 30 minutes

37

What is the IM Glucagon dose for adults?

1mg - for everyone over 30kg

38

What is the dose of glucagon for a 40kg (approx 13 year old) child?

1mg
1ml undiluted

39

What is the dose of IM Glucagon for a child weighing 10kg?

0.5mg

40

What is the dose of glucagon for a 5kg (approx 3 month old) child?

0.5mg

41

Where on a patient do you give and IM injection of glucagon?

Lateral thigh muscle

42

What does IM stand for?

Intramuscular

43

Name the features of Type 1 diabetes.

> 90% of insulin producing cells are permanently destroyed.
little of know insulin produced
dependent on takin insulin injections

44

Why does a patients level of consciousness drop when they become hypoglycemic?

Because the brain is not getting enough glucose.

45

What is the treatment plan for diabetic ketoacidosis?

Primary and secondary survey
BGL
Backup for fluids (R51 for fluids)
Transport to hospital

46

Can you repeat glucagon?

No

47

Why don't you give simple carbohydrates to a patient once you have treated hypoglycaemia?

Because simple carbohydrates such as lollies and sugary drinks are quickly absorbed and another hypoglycaemic event may occur.

48

What are some health risks for diabetic patients?

Infection
Silent MI
Metabolic/electrolyte disorders

49

Will glucagon work if the patient has not eaten in the last 12 hours.

No - there are no glycogen stores as they will have been used up.

50

What is osmotic diuresis?

Excessive urination caused by the presence of substance in the small tubes of the kidneys?
E.g Glucose enters the kidney tubes and cannot get reabsorbed; causes an increase in osmotic pressure in tubule; causes retention of water in lumen; reduces re-absorption of water; increases urine output

51

Name the clinically significant signs and symptoms of diabetic ketoacidosis?

BGL > 20mmol/L
Hypovolaemia from excessive urination and reduced oral intake and vomiting
Generally unwell
Tachyponoea
Fruity Smell to breath (Acetone)
Non specific abdo pain

52

What are some other causes of hypoglycaemia?

Septic shock - particularly children
Poisoning with agents that lower glucose
Liver failure

53

What form would a complex carbohydrate take?

Sandwich containing meat, cheese, peanut butter

54

What are the features of Type 2 diabetes.

body produces insulin but is resistant to it. "insulin resistant"
occurs in adults and children
generally obesity is chief risk factor
initially controlled by oral medication and diet.
eventually will require insulin injections.

55

What is your treatment for a patient with an altered level of consciousness and cannot swallow?

IV glucose or IM glucagon

56

Can you repeat glucagon?

No

57

What is the adult dose for glucagon?

1mg for greater than 30kg

58

What is the dose of glucagon for a child weighing less than 30kg?

0.5mg

59

Do you use the patients own glucose meter?

No use ambulance one

60

What type of diabetic patients usually get hypoglycaemic?

Those taking insulin or oral hypoglycaemics?

61

What is hypoglycaemia?

Low blood glucose level

62

What is the St John threshold for hypoglycaemia?

3.5mmol/l

63

Name some other forms of rapidly absorbed glucose other than hypofit?

Jam
Non diet drink
jellybeans
Glucose tablets

64

Can type two diabetics develop diabetics develop diabetic ketoacidosis?

No but they can develop significant hyperglycaemia without acidosis.

65

What are the criteria for a patient who has had a hyoglycaemic episode to NOT need referral to hospital?

1. Isolated single episode
2. Clear and easily treatable cause
3. Not due to overdose of insulin or oral hypoglycaemics
4. not complicated by seizure or injury
5. Fully recover and mobilse
6. BGL is greater than 3.5mmmol/l after 10 minutes
7. Have a complex carbohydrate
8. Check BGL every hour for 4 hours
9. Adult stay with them for 4 hours
10. See GP to review treatment

66

What should you suspect if a patient taking oral hypoglycaemics develops hypoglycaemia?

Possible kidney failure

Oral hypoglycaemics excreted primarily by kidneys and can lead to deterioration of kidney function.

67

If you have a patient with a high BGL and just generally unwell would you refer them to their GP or transport to hospital?

Transport to hospital - have a low tolerance for GP referrals for unwell diabetic patients.

68

What does DKA stand for?

Diabetic ketoacidosis

69

Can a patient become hyperglycaemic after being treated for hypoglycaemia?

Yes

Must be instructed NOT to treat with insulin


Decks in Ambulance Study Notes Class (79):