CLINICAL- DIABETES Flashcards

Question

Intermediate human insulin injections, used as basal insulin (to cover you throughout day), last for how long?

Answer 1

May only be active for around 8 hours | But provide a higher peak in insulin action that modern basal insulin

Answer 2

Can provide up to 24 hour cover But lower levels than intermediate human insulin Flat and stable action profile

Answer 3

At the injection site Degludec forms soluble hexamers | From here monomers gradually separate and get into blood stream

Answer 4

It's especially important to consider this in hospital setting especially when busy, as the slower onset means that you can give it earlier and it will still be delivered on time

Answer 5

Analogue clear in appearance, isophane is cloudy No peak with analogue, peak for 2-12 hours with isophane Both last for 24 hours There is a risk of night time hypos with isophane insulin

Answer 6

Glargine Detemir Degludec

Answer 7

Insulatard Humulin I Insuman basal Hypurin

Answer 8

Rapid acting insulin

Answer 9

Soluble insulin: Rapid oneself of action: 30-60 mins Peak reached: in 1-5 hours Duration of action: 7-8 hours Give 30 mins before food

Answer 10

Good for patients needing a simple insulin treatment plan E.g. If they're elderly, have poor vision, or are just starting insulin therapy. They contain a basal (long acting) component and a short acting component.

Answer 11

Because premixed injections contain both prandial insulins (short acting human insulin and rapid acting insulin analogues) and basal insulin: so two types if insulin therefore called biphasic

Answer 12

Once a day with largest meal Twice daily with dinner and breakfast Three times daily with each meal Therefore if you saw this prescribed at bed time you would question it!! 

Answer 13

Biphasic analogues: novomix 30, Humalog mix 25 Biphasic insulin: Humulin M3

Answer 14

There's no correct regimen for all people We need to take into account lifestyle and eating habits when deciding which to choose Most common regimens: biphasic analogue mix (the premixed ones) and basal bolus

Answer 15

Premix (biphasic) insulin/ analogue: e.g Humulin M3, Novomix 30, Humalog mix 25 Short acting component: controls rise in BG after breakfast and evening meal Long acting component: maintains glycemic cit risk from lunch until early evening, and then from late evening to next morning; so you can see it must have slower onset than short acting as it doesn't kick in for several hours after

Answer 16

So if you were using Novomix 30: this is 30 units. Need to split in a 2 thirds to 1 third ratio: 20 units given at breakfast 10 units given at dinner Doesn't have to be like this: can give 15 units twice a day!!

Answer 17

Snacks!!  The fact this is needed indicates twice daily (biphasic) regimens have poorer control

Answer 18

Long acting insulin usually given at bedtime : but can be given at any time of day as long as it's the same time !! Short acting then usually given at breakfast lunch and dinner, but patient can adjust their short acting insulin dose according to blood glucose level, exercise and carbohydrates eaten { carbohydrate counting }

Answer 19

More flexibility | Better control

Answer 20

Fewer injections needed: only twice a day More convenient for patient Children wouldn't need to inject as school Although this last point is good, current guidance recommends children are put of basal bolus rather than biphasic, as it offers tighter control and gets children into go habits

Answer 21

 1 unit of insulin for every 10g of carbohydrate

Answer 22

``` Start on a low dose Regularly monitor their blood glucose Adjust dose by 2 units every 2-3 days Make one adjustment at a time Then once patients on 40 units plus, you can adjust by 10% to get optimal control ```

Answer 23

4mm or 5mm This is to avoid intramuscular injection  Children definitely have 4mm

Answer 24

Abdomen (fastest) | Arm, legs, buttocks

Answer 25

They need to be aware that their insulin requirements will drop

Answer 26

Especially in Type 1: blood glucose levels rise during illness There's a special risk of hyperglycaemia This means that people have to continue their insulin as normal even if they are not eating as sugars still high Can lead to DKA

Answer 27

You absorb insulin more readily in hot weather than cold 

Answer 28

A result of constantly injecting in the same place | Patient may like injecting there because it is senseless and numb but they won't get the right amount of insulin!!

Answer 29

Administers insulin through a catheter in the abdomen | Helps control BG level so motivates people

Answer 30

Requires anti rejection medication | Number of patients had it and now are insulin dependent

Answer 31

Just inject a LONG acting insulin once, at the same time each day Examples: insulated, glargine, Levemir Remember prolonged duration of zinc suspension insulin can cause Hypoglyceamia

Answer 32

Severe lack of insulin results in a consistently high blood glucose level.. But glucose can't be used for energy So body starts breaking down body tissues as an alternative energy source The by product is ketones Patient will be vomiting and dehydrated

Answer 33

basal bolus gives you flexibility to delay a meal as it takes away the pre-determined hypo moments that can result from not eating Basal bolus and carbohydrate counting come hand in hand

Answer 34

Decrease insulin before going to bed, not increase it!

Answer 35

Adjust dose of insulin around what we eat So we don't have to do it the other way round and watch what we eat in relation to how much insulin we've had The other factor introduced in carbohydrate counting is the correction dose of insulin: things can send blood sugar up, we need to check BG, then give a dose of insulin to correct it. You have to record everything you eat plus blood sugar levels in a diary

Answer 36

They don't need any No carbohydrates in salad! It's all about adjusting your insulin dose according to how many carbohydrates you eat

Answer 37

People have keto sticks to measure ketones Measure ketones in millimole / ml anything above 1.5 millimole / ml seek urgent help

Answer 38

Dehydration is extremely fast if blood glucose is high (e.g. 40) Can result in death If you vomit more than 3 times then seek help

Answer 39

Review if eGFR is less than 45. Don't use if eGFR is less than 30 If renal function isn't good then consider a gliclazide

Answer 40

Under 130/80 for people with kidney, eye or CV damage For all others the target BP is 140/80

Answer 41

A life-threatening condition seen in T2 diabetes (DKA seen in type 1) Blood glucose becomes extremely high (Plasma glucose level of 600 mg/dL or greater) Most patients present with severe dehydration Some of it's features overlap with DKA. It can cause Coma. It usually occurs in T2 diabetics when they have some other illness causing severe dehydration such as an infection.

Answer 42

6 units of insulin per hour Monitor capillary blood glucose every hour!! Or measure Blood glucose when they come into hospital and use the insulin infusion sliding scale

Answer 43

6-8 L (usually saline/ NaCl)

Answer 44

10-15 g of glucose (55ml of lucozade contains 10g) If unconscious they are brought into hospital and given IV glucose or injected glucagon

Answer 45

Pre prandial : 4- 8 mmol/mol Post prandial: aim for under 10 mmol/mol

Answer 46

Albumin creatinine ratio Over 2.5 in men= albumin in urine= kidney damage in diabetes Over 3.5 in women

Answer 47

More likely to be caused by anaerobic bacteria | So they require broad spectrum antibiotics such as coamoxiclav

Answer 48

Over 13 If not use act-rapid doses to get BG normal.

Answer 49

Ace inhibitors | As they can be renal protective and prevent further deterioration

CLINICAL- DIABETES Flashcards

(74 cards)