DIABETES

Question 1

What are target HbA1c goals for type 1 patients?

Answer 1

48mmol/L

Question 2

What are blood glucose goals across the day?

Answer 2

Fasting; 5-7mmol/L on waking

Before meals and throughput the day; 4-7

90mins after meal; 5-9 mmol/L

When driving 5mmol/L

Question 3

What is recommended dual insulin regime?

What is given if this is not practical?

Answer 3

Basal + Bolus

Bolus given with meals
Basal given once to twice daily

Biphasic insulin ;
Once or twice daily

Question 4

How do insulin pumps work?

Answer 4

It contains a short and long acting insulin. The pump infuses the insulin into the patient s/c slowly- basal control

Press button before meals to give to bolus insulin

Given to patients who suffer from disabling hypoglycaemia or have high HbA1c concs.

Question 5

What can impact the insulin requirements to change?

Answer 5

Increased requirements;

Infection
stress trauma
puberty

Decreased;

endocrine disorders
hepatic impairment r
renal impairment

Pregnancy can increase can decrease requirements

Question 6

Why should patients rotate the site of injection?

Answer 6

Can cause liperhypertrophy

Can cause erratic absorption of insulin resulting in poor glycaemic control

Question 7

When would a diabetic need to inform the DVLA?

Answer 7

If they are taking insulin

Question 8

What advice do the DVLA give to diabetic patients?

Answer 8

They need to be careful to avoid hypoglycaemia and must be aware of the warning signs and what action to take

Drivers treated with insulin must carry a glucose meter with blood glucose strips when driving and c heck their blood glucose levels 2 hours before driving and every 2 hours after.

Blood glucose must always be above 5mmol/L while driving. if falls below; a snack should be taken

If less than 4 mmol/L or symptoms of hypoglycaemia appear the driver should not drive. They must stop driving and eat/ drink some sugar and wait 45 minutes after BG has returned to normal.

Question 9

What are the THREE main complications of diabetes?

Answer 9

Nephropathy

Neuropathy

Ketoacidosis

Question 10

NEPHROPATHY;
What is the earliest sign of nephropathy?

Answer 10

Microalbuminuria so patient should have annual test for urinary protein.

Question 11

NEPHROPATHY;
What should ALL patients be offered if they have nephropathy with proteinuria/microalbuminuria?

Answer 11

ACEi
ARB

Patients should not be given both as patients with nephropathy are at higher risk of causing hyperkalaemia

Question 12

NEUROPATHY;
What is first line treatment for mild to moderate pain?

Answer 12

Paracetamol
NSAID

Question 13

NEUROPATHY;
What is used when very painful?

Answer 13

Duloxetine
Amitriptyline
Pregabalin

May respond to opioid analgesic
Tramadol’ 1st
Morphine
oxycodone

Question 14

KETOACIDOSIS;
What group of diabetics is this most common in and why?

Answer 14

type 1
As no insulin is produced, fat is broken down ( as no insulin is present to stop this from occurring) causing ketone production.

Question 15

What are side effects of diabetic ketoacidosis?

Answer 15

it is a form of hyperglycaemia that occurs very quickly (>20mM) ketones irritate vomiting centre, leading to a depletion in potassium levels.

Any remaining potassium will be taken up into cells, worsening hypokalaemia .

Question 16

What is treatment for diabetic ketoacidosis?

Answer 16

1. Rehydrate
   without glucose= NaCl
   Replenish potassium
2. IV insulin infusion
   to reduce blood glucose and ketone bodies. Soluble insulin should be diluted and mixed thoroughly with saline. BG should fall by at least 3mmol/L/hour
3. Continued until ketone levels fall below 0.3mmo/L and patient is able to eat and drink.
4. Once blood glucose has gone below 14mmol/L=

Glucose 10% should be given via IV infusion in addition to 0.9% saline infusion to prevent hypoglycaemia.