Diabetes Flashcards

1
Q

what is the target HbA1c

A

<58

<48 by NICE within 1st year of treatment

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2
Q

What HbA1c level related to poor control

A

> 75

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3
Q

What is the target glucose before meal

A

4-7

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4
Q

what is the target glucose 2 hours after meals

A

5-9

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5
Q

what is the target glucose before bed

A

4-7

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6
Q

What is a typical insulin regimen?

A

background basal insulin - lantus

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

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7
Q

how long does insulin last before a meal

A

4 hours

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8
Q

history taking aspects for DM

A
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
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9
Q

features of DKA

A
tachypnoea 
tired 
polyuria 
polydipsia
vomiting 
confusion 
collapse 
abdominal pain 
Kussmaul breathing
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10
Q

examination findings of DKA

A
kussmaul breathing 
sweet smelling breath 
cool peripheries 
dry 
increase skin turgor 
sunken eyes 
confusion 
abdominal pain 
increased toe-core gap
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11
Q

investigations for DKA

A
urinalysis 
NPT - glucose and ketones 
capillary or venous gas 
FBC, U+E, glucose, CRP +- culture 
HbA1c 
anti-GAD 
additional Ix depending on situation
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12
Q

aims of DKA management

A

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

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13
Q

Management of DKA

A
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
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14
Q

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

A

false, insulin is only given after the 1st hour

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15
Q

BSPED

A

useful DKA guideline

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16
Q

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

A

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

17
Q

converting IV to SC insulin

A

starting: 0.5 units/kg/day

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

18
Q

what is the 100 rule - ISF

A

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

19
Q

what is the 300 rule - ICR

A

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

20
Q

no more than how many hypos a week

21
Q

how to achieve target blood glucose levels

A

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

22
Q

data review for blood glucose

A

review 14 day average every 2 weeks

should be <8

23
Q

causes for high blood glucose

A

miss an injection
stress
infection
miscalculation

24
Q

when to check for ketones

A

x2 BG >14

if you are unwell

25
if vomiting, assume DKA until proven otherwise, true or false
true
26
BG level for hypos
<4
27
symptoms of hypos
``` tired shaky lips tingling feeling tearful blurred vision lack of concentration feeling hungry headache irritable sweating going pale ```
28
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
29
management of severe hypos
IM glucagon into thigh only if parent is comfortable doing this call 999