Diabetes

Question 1

Hypoglycaemia values

Answer 1

CBG <3mmol/L

Question 2

Hyperglycaemia values

Answer 2

CBG >11mmol/L

Question 3

Normal values for CBG

Answer 3

4-7mmol/L

Question 4

Which cells are responsible for the secretion of insulin

Answer 4

Beta cells within the cells of the pancreas called islets of Langerhans

Question 5

Which cells are responsible for the secretion of glucagon

Answer 5

Alpha cells of the islets of langerhans within the pancreas

Question 6

Triggers for insulin release

Answer 6

Increased plasma glucose concentration
Increased amino acids
Increased sympathetic input

Question 7

What is the duration of the half life of insulin?

Answer 7

4-6minutes

Question 8

What enzyme and organs remove insulin from circulation?

Answer 8

Insulase removes 60%.

Skeletal muscle, adipose tissue and the liver remove the remaining 40%.

Question 9

Meaning of mild hyper/hypoglycaemia

Answer 9

Recognised by self and self resolving

Question 10

Meaning of severe hyper/hypoglycaemia

Answer 10

Pt unable to recognise and self manage, requires treatment by a 3rd party

Question 11

Lifestyle factors that can contribute to hypoglycaemic episode

Answer 11

Exercise 
Occupation- shift work 
Diet 
Smoking 
Fasting/meal skipping 
Alcohol

Question 12

Medical treatments that may lead to hypoglycaemic episode

Answer 12

RRT 
Over administration of insulin 
Warfarin 
Surgery 
Nil by mouth 
NSAIDS 
Monoamine oxidase inhibitors (MOIs)

Question 13

Route through which glucogel should be administered

Answer 13

Buccal

Question 14

What does DKA stand for?

Answer 14

Diabetic ketoacidosis

Question 15

Signs and symptoms of hyperglycaemia

Answer 15

Severe unquenchable thirst 
Headache 
Polyurea 
Anxiety 
Blurred vision 
Warm dry skin 
Leg cramps 
Increased RR 
Weight loss 
Vomiting 
Confusion 
Ketone urea

Question 16

Risk factors for hyperglycaemia

Answer 16

Infection 
Illness 
Stress 
Decreased level of exercise/activity 
Diarrhoea

Question 17

In DKA what is the rate of insulin administration with FRIII?

Answer 17

0.1u/kg/hr

Question 18

Whilst pt is on sliding scale should Lantus be omitted?

Answer 18

No.

Question 19

Following DKA how often should CBG be checked?

Answer 19

Once every hour

Question 20

What can hypos lead to?

Answer 20

MI
Coma
Seizures
Cognitive function

Question 21

What are the symptoms of hypoglycaemia? (loads)

Answer 21

Weakness 
Shaking 
Sweating 
Tachycardia 
Palpitations 
Nervousness 
Irritability 
Tingling of mouth and fingers 
Hunger 
Headache 
Hypothermia 
Visual disturbance 
Confusion

Question 22

What are symptoms of hyperglycaemia? (loads)

Answer 22

Thirst 
Polyuria 
Fatigue 
Weight loss 
Nausea 
Tachycardia 
Hyperventilation 
Ketosis 
Warm dry skin 
Hypotension 
Bradycardia 
Decreased resps
Hypothermia 
Hypoxia 
Coma

Question 23

What is the clinical criteria for admission to HDU with hyperglycaemia?

Answer 23

Ketones >6mmol/L 
Bicarbonate <5mmol/L 
pH <7.1 
Hypokalemia <3.5mmol 
GCS <12 
O2% <92 on air 
Sys <90mmHg 
HR >100/<60

Question 24

What are the treatment priorities in hyperglycaemia?

Answer 24

Correct dehydration and electrolyte imbalance
Enable uptake of glucose into cells
Increase blood pH

Question 25

What is the therapy commenced in hyperglycaemia?

Answer 25

Fixed Rate Intravenous Insulin infusion (FRIII)

Question 26

When would you give a stat dose of insulin in hyperglycaemia requiring FRIII?

Answer 26

If there is a delay in setting up FRIII

Question 27

What should be monitored hourly when using fixed rate intravenous insulin infusion?

Answer 27

Blood glucose

Ketones

Question 28

What is the aimed rate of ketone reduction in DKA?

Answer 28

0.5mmol/hour

Question 29

What treatment in DKA improves pH?

Answer 29

Administration of insulin

Reduction of ketones