Flashcards in 4.0 & 4.1 Hyperglycaemia and Hypoglycaemia Deck (69)
What are the signs and symptoms of hypoglycaemia?
Rapid onset of altered mental status
anxious, restless aggressive
Tachycardia (thumping heart)
Cool, moist skin
Bruising at insulin site
BSL < 3.5 mmol
What are some other conditions (comorbidities) that diabetic patients can have, as well as diabetes?
Ischaemic heart disease
Peripheral vascular disease
What are some associated health risks for patients with diabetes?
silent myorcardial infarction
What is the St John threshold for hypoglycaemia?
What is the acceptable range for BSL according to St John?
3.5 - 7.0 mmol
Do you use a patients own glucose meter to measure BSL?
What is hypoglycaemia?
Low blood sugar
What type of diabetic patients normally get hypoglycaemic?
Those taking insulin or oral hypoglycaemics.
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.
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
If you have a conscious patient with a BSL < 3.5 mmol - what is your initial treatment?
Oral glucose to recover BSL.
What is your treatment for a patient with hypoglycaemia,an altered LOC and cannot swallow?
patient requires IV access for glucose
if not able to get IV access give IM Glucagon.
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.
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)
Name some examples of complex carbohydrates?
peanut butter sandwich
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.
What is hyperglycaemia?
High blood sugar.
Higher than 20 mmol according to St John guidelines.
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
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
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.
Can a patient become hyperglycaemic after being treated for hypoglycaemia?
Must be instructed NOT to treat with insulin
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.
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.
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.
What does DKA stand for?
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.
Fat is metabolised for energy (produces ketones/acidosis) creating an acidic environment.
What are the signs and symptoms of someone who has DKA?
poor skin turgor
rapid, deep respirations
fruity, acetone breath
altered LOC due to dehydration
warm, dry, flushed skin
coma (very late)
Can type two diabetics develop diabetic ketoacidosis?
Not generally - but they can develop significant hyperglycaemia without acidosis.
What is glucagon used for?
The treatment of hypoglycaemia when a patient:
cannot swallow glucose AND
when IV access cannot be obtained