Modules Flashcards
who should be referred to the specialist diabetes team on admission to hospital (8)?
DKA diabetes and pregnancy new type 1 diagnosis HHS recurrent or severe hypoglycaemia Poor glycaemic control Require insulin initiation complications such as autonomic neuropathy and/or foot ulcers
what unrelated illnesses/treatments may cause a required alteration to diabetes treatment?
acute coronary syndrome parenteral feeding vomiting sepsis treatment with corticosteroid IV insulin for >48 hrs Continuous subcutaneous insulin infusion pumps
who is at increased risk of foot problems while in hospital?
patients with neuropathy
previous ulcer or amputation
bed bound or fragile skin
a what points should blood glucose be measured in a diabetic patient during a hospital stay?
- on admission
2. before every SC insulin injection, or hourly while on IV insulin
how often is blood glucose measured if unwell patient?
4 times per day
when is blood glucose checked if hypoglycaemic?
15 mins after administering treatment (to check if its working)
how often do you check blood glucose if on SURs vs metformin?
SURs = twice daily metformin = once daily (before meals)
how often do you check blood glucose in diet controlled diabetic?
once daily (before meals)
definition of hypoglycaemia in people on treatment for diabetes?
<4mmol/L
which hormones are involved in the autonomic nervous system response to blood glucose?
cortisol
glucagon
adrenaline
growth hormone
how does the liver respond to hypoglycaemia and how can this be impaired>
releases glucose from glycogen stores can be impaired in people with - malnourished - extensive liver disease - recurrent hypoglycaemia - consumed alcohol to excess
what are the autonomic symptoms of hypoglycaemia?
trembling anxiety numbness/tingling palpitations irritability hunger pale and sweaty vulnerable and afraid
what causes neuroglycopaenic symptoms in a hypoglycaemic episode?
when blood glucose falls <2mmol/L, impaired supply to the brain
what neuroglycopaenic symptoms can occur with hypoglycaemia?
problems with weakness, coordination and concentration slurred speech problems with vision loss of consciousness seizures
how can hypoglycaemia be quickly managed in patients who can swallow?
give quick acting carbohydrates
- 150-200ml fruit juice (avoid in renal failure)
- 60ml glucojuice
- 4-5 glucotabs
how can hypoglycaemia be quickly managed in patients who are drowsy/confused but can swallow?
glucose gel
1.5-2 tubes squeezed between teeth and gums
how can hypoglycaemia be managed in an unconscious patient?
ABCDE
call a doctor
stop any IV insulin
IV glucose or IV/intra-muscular glucagon
how is IV glucose administered?
150ml 10% glucose over 10-15 mins
75ml 20% glucose over 10-15 mins
what may reduce the effectiveness of glucagon injection?
liver disease
malnourishment
repeated hypoglycaemia
OHA induced hypoglycaemia
how is glucagon administered?
don’t use in OHA induced hypo
1mg in adults (>25kg)500 micrograms in kids <8 (<25kg)
store in the fridge
given via subcutaneous, intramuscular or IV injection
how do you know if further glucose treatment is needed in hypoglycaemia?
if blood glucose is still >4 after 15 mins
where are the common sites for subcutaneous insulin injection?
abdomen
upper outer thigh
upper outer leg
buttocks
what are the 4 key principles of insulin injection?
rotate site for each injection (i.e if injecting 4 times a day - inject at different site each time)
use the same general location for injection at the same time of day
change the pen needle or syringe each time
inject the same insulin in the same area every day (e.g long acting always in the abdomen) while ensuring that you rotate the specific site of injection within the area each time
what is the most common complication that can occur at insulin injection sites and what are the implications of this?
lipohypertrophy at site of repeated injection
causes reduced absorption of insulin at that site so should be avoided for insulin injection
