(PM3B) Diabetes Self-Care & Management

Question 1

What support are pharmacists expected to offer for diabetic patients?

Answer 1

(1) Diet & lifestyle advice

(2) Offer locally commissioned services, e.g. weight management programmes

(3) NMS and MUR

Question 2

What monitoring is required for diabetic patients?

Answer 2

(1) Signs + symptoms of hypo/ hyperglycaemia

(2) Signs + symptoms of chronic complications

(3) Blood glucose level - daily required for young people with type 1

Question 3

What are the aims of treatment for diabetic patients?

Answer 3

(1) Improve QoL
(2) Regulate blood glucose
(3) Reduce risk of co-morbidities (complications)
(4) Reduce mortality

Question 4

What is/ are the main treatment option(s) for Type 1 diabetes mellitus?

Answer 4

Insulin

Question 5

What is/ are the main treatment option(s) for Type 2 diabetes mellitus?

Answer 5

(1) Metformin/ suphonylurea - especially if overweight

(2) Insulin

(3) Diet

Question 6

What should diabetic patients know about their treatment?

Answer 6

(1) Types of insulin
(2) Pen/ syringes other equipment

Question 7

What should be done with old insulin?

Answer 7

Disposed of

To make sure it is not confused with new insulin

Question 8

Can a patient administer their own insulin in hospital?

Answer 8

Yes.

They must tell staff they wish to continue administering their own insulin

Question 9

What is biphasic insulin?

Answer 9

A combination/ mix of insulin
- Rapid/ short-acting
- Intermediate

Question 10

What types of insulin are there?

Answer 10

(1) Pre-loaded disposable pen
(2) Re-usable injection pen

Question 11

Can IV syringes be used for insulin self-administration?

Answer 11

No. They should be avoided

Question 12

How should a syringe be described on the box for it to be considered appropriate for insulin administration?

Answer 12

“Insulin syringe”

Question 13

How should insulin that is IN USE be stored?

Answer 13

Below 25ºC

But NOT in the fridge

Up to 4 weeks

(2-8ºC fridge if not yet in use)

Question 14

What does a lumpy injection site indicate?

Answer 14

Lipohypertrophy - can affect absorption

Question 15

What can lipohypertrophy affect?

Answer 15

Absorption of the the drug

e.g. insulin

Question 16

Name potential insulin injection sites, list them from fastest to slowest absorption.

Answer 16

(1) Abdomen
(2) Arms
(3) Thigh
(4) Buttocks

Question 17

How can lipohypertrophy be avoided?

Answer 17

Rotate injections sites

Important to use both left and right

Question 18

What is an insulin passport?

Answer 18

A record of the patient’s current insulin preparations

Also emergency information

Comes with a patient information leaflet

Question 19

What is also given with an insulin passport to the patient?

Answer 19

Patient information leaflet

Information on how to safely administer insulin

Question 20

What is the clinical diagnosis for hypoglycaemia?

Answer 20

<4mmol/L plasma glucose

Question 21

What are common symptoms of a hypoglycaemic episode?

Answer 21

(1) Shaky/ dizzy
(2) Sweaty
(3) Irritability
(4) Fatigue

Question 22

What is the first line treatment for hypoglycaemia?

Answer 22

Immediate treatment:
ø 10-20g of rapidly-acting carbohydrate (sugar)

Question 23

How can hyperglycaemia be managed?

Answer 23

(1) Increased dose of insulin
(2) Change diet to avoid sugary foods
(3) Increase exercise
(4) Monitor glucose levels regularly

Question 24

What does extreme hyperglycaemia cause?

Answer 24

Diabetic Ketoacidosis

Question 25

How are blood glucose levels affected by illness? What is this referred to as?

Answer 25

(1) Usually increase (2) Sick day rules

Question 26

What are patients on insulin also given?

Answer 26

(1) Insulin passport (2) Urine strips to test for ketones

Question 27

When sick, how often should a Type 1 diabetic patient check their blood glucose? What else is monitored?

Answer 27

Every 4 hours Also urinary ketones

Question 28

What drugs can cause kidney damage to a diabetic patient when dehydrated?

Answer 28

- ACE inhibitors - ARBs - NSAIDs

Question 29

What is blood glucose level is considered hypoglycaemia?

Answer 29

>11mmol/L

Question 30

What is the increased risk of stroke for a diabetes patient?

Answer 30

2-4x as likely

Question 31

What would you advise a diabetic patient intending to fast, including for Ramadan?

Answer 31

AVOID fasting Break the fast if blood glucose <3.5mmol/L

Question 32

What is amenorrhoea?

Answer 32

Absence of monthly period

Question 33

What is cystitis?

Answer 33

Inflammation of the bladder Normally due to infection

Question 34

What would be your recommendation for a diabetic patient presenting with cystitis?

Answer 34

Refer to GP Increased risk of nephritis

Question 35

What should be recommended for a diabetic patient presenting with an insect bite?

Answer 35

Recommend insect repellant Refer if not improved in 1-2 days AVOID hydrocortisone cream

Question 36

What are the requirements for a diabetic patient, regarding their driving licence?

Answer 36

(1) Inform DVLA of their condition (2) Avoid hypoglycaemia - check blood glucose before driving (3) Carry a supply of sugar in the car (4) If experiencing hypoglycaemia/ symptoms STOP and consume sugar. WAIT 45 mins before continuing

Question 37

What effect can hot climates have on insulin?

Answer 37

May require more insulin

Question 38

What does a diabetic patient require before using air travel?

Answer 38

A letter from the GP Explaining need for carrying syringes + needles + insulin

Question 39

Should diabetic patients be advised to get a flu jab?

Answer 39

Yes. Flu vaccine is important for diabetic patients. Pneumococcal pneumonia vaccination is also recommended