Diabetes Flashcards
what is the target HbA1c
<58
<48 by NICE within 1st year of treatment
What HbA1c level related to poor control
> 75
What is the target glucose before meal
4-7
what is the target glucose 2 hours after meals
5-9
what is the target glucose before bed
4-7
What is a typical insulin regimen?
background basal insulin - lantus
fast acting novorapid 15 min before a meal 3 times a day
how long does insulin last before a meal
4 hours
history taking aspects for DM
time of Dx symptoms leading to Dx hospital admission any new symptoms - 4Ts infections how is glucose control control compliance recent hypos/hypers do they know what to do in these cases school diet
features of DKA
tachypnoea tired polyuria polydipsia vomiting confusion collapse abdominal pain Kussmaul breathing
examination findings of DKA
kussmaul breathing sweet smelling breath cool peripheries dry increase skin turgor sunken eyes confusion abdominal pain increased toe-core gap
investigations for DKA
urinalysis NPT - glucose and ketones capillary or venous gas FBC, U+E, glucose, CRP +- culture HbA1c anti-GAD additional Ix depending on situation
aims of DKA management
treat shock - ABCDE
fluid boluses
stop ketosis: rehydrate, commence insulin
monitor electrolytes
vigilance
convert to SC insulin once ketosis reversed
Management of DKA
O2 if <94% IV access if shocked: 0.9% NaCl bolus 10ml/kg after 1st hour - start replacement fluids and IV insulin 0.05-0.1 units/kg/hr hourly rate
in the first hour of DKA management you can give insulin, true or false
false, insulin is only given after the 1st hour
BSPED
useful DKA guideline
what is the 4,2,1 rule for maintenance fluid prescription ml/hour
4ml/kg for 1st 10kg
2ml/kg for 2nd 10kg
1ml/kg thereafter
converting IV to SC insulin
starting: 0.5 units/kg/day
1/2 long acting, 1/2 as novorapid bolus
what is the 100 rule - ISF
100/TDD (total daily dose) gives the amount your sugar will drop with 1 unit of insulin
what is the 300 rule - ICR
300/TDD gives the amount of CHO covered by 1 unit of insulin
no more than how many hypos a week
1-2
how to achieve target blood glucose levels
check BG 5-7 times a day
count your carbs
give insulin 15 min before eating
rotate your injection sites
data review for blood glucose
review 14 day average every 2 weeks
should be <8
causes for high blood glucose
miss an injection
stress
infection
miscalculation
when to check for ketones
x2 BG >14
if you are unwell
if vomiting, assume DKA until proven otherwise, true or false
true
BG level for hypos
<4
symptoms of hypos
tired shaky lips tingling feeling tearful blurred vision lack of concentration feeling hungry headache irritable sweating going pale
management of hypo
15g of fast acting carb
juice, glucotabs, fizzy drinks, full sugared juice, sweeties
liquids are better
no chocolate or fat!! this slows down treatment
management of severe hypos
IM glucagon into thigh
only if parent is comfortable doing this
call 999
