1 Diabetes Workshop

Question 1

How do glargine and detemir slow absorbtion?

Answer 1

Glargine - micropercipitate around injection sight

Detemir - reversibly binds to albumin

Question 2

With what regime to you need to adjust the insulin according to carb amount?

Answer 2

Multiple daily dose.

With fixed dose regimes carbs should be spread throughout the day

Question 3

What is DKA?

Answer 3

Lack of insulin leads to hyperglycaemia, ketosis and metabolic acidosis.
The body burns fat instead of sugar producing ketones.

Question 4

Symptoms

Answer 4

Thirst , polyuria, confusion, fatigue and nausea

Question 5

Treatment outline for DKA

Answer 5

Fluids (excessive urination loosing glucose and water)
Insulin (to suppress ketone production)
Potassium (as insulins causes glucose and k to go into cells)

Fluids: use isotonic saline, when plasma gluc has fallen use glucose containing fluid (as a substrate for insulin and to avoid hypo)

Question 6

Levels indicating DKA

Answer 6

BG > 11mmol/l
Urine positive for ketones or blood high in ketones
Acidosis (pH

Question 7

Should diabetic eat on the morning of surgery

Answer 7

No - omit breakfast, insulin and oral hypoglycaemic

I think this is just the short acting insulins, you would have had a long acting the night before

Question 8

When to stop IV insulin after surgery

Answer 8

Switch to normal when patient starts to eat . Stop IV 30 mins after the first sub cut injection

Question 9

Sick day rules if you vomit

Answer 9

Must be stopped with antiemetics

Question 10

Sick day rules, keep taking…. And ….

Answer 10

Fluids and insulin (may need to be increased)

Sip sugary drinks

Question 11

What is in VRii?

Answer 11

Insulin and dextrose to avoid hypo.

Hourly obvs

Question 12

What happens in severe hypo?

Answer 12

Inadequate supply of glucose to the brain

Question 13

How to distinguish between DKA and hypo

Answer 13

DKA - nausea and vom, dry skin, fruity breath, rapid breathing, drowsiness
Hypo - sweating, tachy, confusion, personality change, seizures

Question 14

Hypo level

Answer 14

Less than 3.5mmol/L

Question 15

Why not monitor urine in type one 3

Answer 15

Time frame is inaccurate, can only detect high levels (

Question 16

Would you use a dip stick in type two?

Answer 16

Probably one - we are more interested in long term so hba1c . Might use a dip stick to check if there is a problem

Question 17

Contrast biphasic and

mdi

Answer 17

MDI - more flexible, more accurate copy of troughs.

Basal bolus - fewer injections, no need to inject at school

Question 18

Young person blood pressure targets

Answer 18

4-8 before meals, under 10 after

Question 19

Things you could do to improve insulin control 6

Answer 19

Change to MDI
Check complience
Check injection site and technique
Increase insulin dose
Encourage self monitoring
Exercise and weight loss to reduce need

Question 20

Guidline for increasing insulin dose

Answer 20

2 units or 10% adjustment
For rapid acting this can be daily,
For long acting every 3 days

Question 21

Name some long term complications of diabetes

Answer 21

Micro vascular like neuropathy, retinopathy

Macrovascular like MI, stroke, vascular disease

Question 22

Why are analogues more rapidly absorbed than soluble?

Answer 22

Analogues remain as monomers

Soluble becomes he oner and must dissociate to be absorbed.