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Flashcards in EAC Diabetes and Drug Therapy Deck (21):
1

define:
Diabetes Mellitus

A disorder where there is inadequate insulin for carbohydrate metabolism.

Glucose absorbed form the GI tract cannot be metabolised or stored and so reaches higher than normal levels in the bloodstream.

2

2 types of Diabetes Mellitus

Insulin dependant diabetes mellitus: type 1 IDDM
-insulin not being produced at all


Non-insulin dependant diabetes mellitus: Type 2 NIDDM
-Insulin is released but the receptor sites have mutated and insulin is unable to enter the cells to allow sufficient glucose absorption

3

How the body normally regulates blood sugar

The pancreas has the ability to determine the level of sugar in the blood and releases different hormones to regulate this.

Glucagon released by alpha cells of pancreas causes the liver releases glucose into the blood.

Insulin released by beta cells of pancreas causing fat cells to take in glucose from the blood.

4

complications of Diabetes

Cardiovascular disease
Neuropathy (dysfunction of peripheral nerves)
Nephropathy (kidney disease)
Renal failure
Infection
Hypoglycaemia coma
Hyperglycaemia coma

5

complications of diabetes:
Cardiovascular disease

Atheroma and calcification of the tunica media of large arteries, leading to peripheral vascular disease, MI, cardiovascular disease

Thickening of the epithelial basement membrane of arterioles, capillaries and vessels leading to:
Peripheral vascular disease
Retinopathy
Nephrotic syndrome and renal failure
Peripheral neuropathy (damage to nerves causing diminished sensation in lower limbs and bladder problems)

6

complications of diabetes:
Infection

Diabetics are very susceptible to infection, especially from bacteria and fungi

7

complications of diabetes:
Renal Failure

Due to vascular changes and infection, it is a common cause of death in diabetics

8

complications of diabetes:
Hypoglycaemia

can occur in type 2 and type one diabetics.

This occurs in insulin dependant diabetics where insulin administered is in excess of that needed to balance food intake and expenditure of energy. It will lead to coma and if prolonged, irreversible damage can occur

9

complications of diabetes:
Hyperglycaemia

it is accompanied by disturbances of the acid base balance of the body, and is most common in insulin dependent diabetics. Its onset is gradual and often follows an infection and gradual loss of diabetic control.

10

aetiology (causes) of:
Hypoglycaemia

Overdose of insulin
Food intake inadequate
Overdose of oral agents
GI disturbances eg, vomiting, diarrhoea
Unexpected exercise
Excess consumption of alcohol
Hepatic or renal dysfunction
Other illnesses inc. infection
Alcohol intake
pregnancy and breastfeeding
the elderly

11

aetiology (causes) of:
Hyperglycaemia

Poor diabetic control; failure of the patient to administer the required dose of drugs
Inadequate adjustment of the prescribed dose to meet the patients needs
The presenting feature of diabetes, especially in the young
Undiagnosed diabetes
Illness
Infection
Myocardial infarction
Medication including steroids

12

signs and symptoms of:
Hyperglycaemia

Polyuria
Polydipsia (thirsty)
Polyphagia (hungry)
Ketone breath
Kussmaul's respiration (deep/laboured)
Lethargy and confusion
Dehydration and signs of shock
Hyperventilation
Rapid weight loss
Unconsciousness
Low blood pressure
Abdo pain, nausea, vomiting
Dry skin
Rapid weak pulse
abnormally high BM

13

management of:
Hyperglycaemia

DRABCDE
correct AB problems time critical
measure BM
Record ECG
O2 if required
placing in the recovery position if unconscious
Pre-alert time critical transfer

Paramedic/CHUB or GP advise must be sought before leaving patients at home.

14

Non-conveyed Non-diabetic patients: HYPER

Routinely assess BM of all patients >40 years

BM 8-12.9 = letter sent to GP within 3 weeks for follow up blood test
BM >13 = Contact EBS to make GP referral for follow up within 24-48 hours
BM >25 = convey to hospital if declined contact EBS for GP referral

one test doesn't diagnose
record/handover: weight loss, >thirst, weakness
risk factors: excess weight, sedentary lifestyle, bad diet, smoking

15

signs and symptoms of:
Hypoglycaemia

Autonomic: sweating, palpitations, shaking, hunger

Neurological: confusion, drowsiness, odd behaviour, speech difficulty, un-coordination, aggression, fitting, unconsciousness

General malaise: headache, nausea

16

management of:
Hypoglycaemia

MILD: orientated, able to swallow
administer 15-20g of quick acting carbohydrate
Ensure BM>5mmol
If no improvement repeat up to 3 times
Consider paramedic assistance if no improvement

MODERATE: impaired LoC, uncooperative, >risk of aspiration or choking
If capable and cooperative administer 15-20g quick acting carbohydrate. If NOT capable and cooperative but able to swallow administer 1-2 tubes of Dextrose gel 40% or IM Glucagon.
Ensure BM>5mmol and >LoC
If no improvement repeat glucose Gel 3x
Consider paramedic assistance if no improvement

17

How is Diabetes controlled?

IDDM - insulin injections

NIDDM - diet, medication, insulin injections

18

Normal blood glucose levels

4-7mmol before meals

19

when can HYPO patients be left at home?

mild or moderate events where the patient has recovered BM>5, have eaten complex carbohydrates and are in the care of a responsible adult

20

HYPO patients who should receive hospital care

those who have had recurrent treatment within the last 48 hours
Patients taking sulfonylureas
First episode of HYPO and not known diabetic
BM

21

5 key messages for HYPO patients

eat regular meals, don't miss meals and ensure dose and timing of medications are correct, unless advised by GP

HYPO events requiring ambo are serious: advise GP for assistance and review of medication regime

Test BM frequently over next 24 hours

If required make changes to food intake to match activity levels

Consented to ring back within 2 hours? ensure you are available on the number given