Diabetes

Question 1

what is the target HbA1c

Answer 1

<58

<48 by NICE within 1st year of treatment

Question 2

What HbA1c level related to poor control

Answer 2

> 75

Question 3

What is the target glucose before meal

Answer 3

4-7

Question 4

what is the target glucose 2 hours after meals

Answer 4

5-9

Question 5

what is the target glucose before bed

Answer 5

4-7

Question 6

What is a typical insulin regimen?

Answer 6

background basal insulin - lantus

fast acting novorapid 15 min before a meal 3 times a day

Question 7

how long does insulin last before a meal

Answer 7

4 hours

Question 8

history taking aspects for DM

Answer 8

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

Question 9

features of DKA

Answer 9

tachypnoea 
tired 
polyuria 
polydipsia
vomiting 
confusion 
collapse 
abdominal pain 
Kussmaul breathing

Question 10

examination findings of DKA

Answer 10

kussmaul breathing 
sweet smelling breath 
cool peripheries 
dry 
increase skin turgor 
sunken eyes 
confusion 
abdominal pain 
increased toe-core gap

Question 11

investigations for DKA

Answer 11

urinalysis 
NPT - glucose and ketones 
capillary or venous gas 
FBC, U+E, glucose, CRP +- culture 
HbA1c 
anti-GAD 
additional Ix depending on situation

Question 12

aims of DKA management

Answer 12

treat shock - ABCDE
fluid boluses
stop ketosis: rehydrate, commence insulin
monitor electrolytes
vigilance
convert to SC insulin once ketosis reversed

Question 13

Management of DKA

Answer 13

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

Question 14

in the first hour of DKA management you can give insulin, true or false

Answer 14

false, insulin is only given after the 1st hour

Question 15

BSPED

Answer 15

useful DKA guideline

Question 16

what is the 4,2,1 rule for maintenance fluid prescription ml/hour

Answer 16

4ml/kg for 1st 10kg
2ml/kg for 2nd 10kg
1ml/kg thereafter

Question 17

converting IV to SC insulin

Answer 17

starting: 0.5 units/kg/day

1/2 long acting, 1/2 as novorapid bolus

Question 18

what is the 100 rule - ISF

Answer 18

100/TDD (total daily dose) gives the amount your sugar will drop with 1 unit of insulin

Question 19

what is the 300 rule - ICR

Answer 19

300/TDD gives the amount of CHO covered by 1 unit of insulin

Question 20

no more than how many hypos a week

Answer 20

1-2

Question 21

how to achieve target blood glucose levels

Answer 21

check BG 5-7 times a day
count your carbs
give insulin 15 min before eating
rotate your injection sites

Question 22

data review for blood glucose

Answer 22

review 14 day average every 2 weeks

should be <8

Question 23

causes for high blood glucose

Answer 23

miss an injection
stress
infection
miscalculation

Question 24

when to check for ketones

Answer 24

x2 BG >14

if you are unwell

Question 25

if vomiting, assume DKA until proven otherwise, true or false

Answer 25

true

Question 26

BG level for hypos

Answer 26

<4

Question 27

symptoms of hypos

Answer 27

tired 
shaky 
lips tingling 
feeling tearful 
blurred vision 
lack of concentration 
feeling hungry 
headache 
irritable 
sweating 
going pale

Question 28

management of hypo

Answer 28

15g of fast acting carb
juice, glucotabs, fizzy drinks, full sugared juice, sweeties
liquids are better
no chocolate or fat!! this slows down treatment

Question 29

management of severe hypos

Answer 29

IM glucagon into thigh
only if parent is comfortable doing this
call 999