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3B General Care > Diabetes e-learning > Flashcards

Diabetes e-learning Flashcards

1
Q

Diabetic Ketoacidosis signs

A

Tachycardia
Rapid resp rate
Low BP

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2
Q

Diagnosing DKA

A

Urine ketones >++
Blood glucose > 11mmol
Venous pH <7.3
Serum Bicarbonate < 16mmol

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3
Q

Causes of hypoglycaemia in hospital patients

A
  1. Too much insulin/ sulphonylureas
  2. Not enough food
  3. Delayed/ missed meals or snacks
  4. Other illnesses esp. renal impairment
  5. Exercise (e.g. physio)
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4
Q

Examples of sulphonylueas

A

glicazide or tolbutamide

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5
Q

Why do sulphonylureas cause hypoglycaemia?

A

Trigger the pancreas to release insulin

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6
Q

Why does renal impairment lead to hypoglycaemia?

A

Most diabetic medications are renally excreted so stay in the system for longer when renal function is impaired, leading to hypoglycaemia.

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7
Q

Adrenergic Hypoglycaemia

A
  • Noradrenaline, adrenaline and hypoglycaemia
  • work with glucagon to oppose insulin
  • raise blood glucose
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8
Q

Neuroglycopenic Hypoglycaemia

A
  • consequence of low blood glucose on the brain

- brain function is impaired below blood glucose of 3.5 mmol

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9
Q

Signs of Adrenergic Hypoglycaemia

A

Pallor, Perspiration, Bradycardia, Tremor, Tachycardia

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10
Q

Symptoms of Adrenergic Hypoglycaemia

A

Sweating, Shaking, Anxiety, Palpitations, Tingling Lips

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11
Q

Signs of Neuroglycopenic Hypoglycaemia

A

Confusion, Irritability, Lethargy, Fitting, Odd Behaviour, Slurred Speech, Coma, Hemi-paresis

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12
Q

Symptoms of Neuroglycopenic Hypoglycaemia

A

Difficulty speaking/concentrating, visual disturbances, Drowsiness, Hunger, Dizziness

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13
Q

Treating Hypos- conscious pt, able to swallow

A

glucojuice/ glucotabs

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14
Q

Treating Hypos- conscious pt, able to swallow not able to cooperate

A

Glucogel

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15
Q

Treating Hypos- pt unconscious, maybe fitting, has IV access

A

10% glucose with giving set

3 way tap, 50ml syringe for 50ml boluses

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16
Q

Treating Hypos- pt unconscious, no IV access

A

Glucagen

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17
Q

Dose Reduction after Hypoglycaemia

Sulphonylureas

A
  • BG may be low for 24-48 hours
  • continue 100mls/hr 10% glucose after hypoglycaemia coma
  • omit further doses until Diabetes review if BG <3mmol
  • Reduce dose by 50% if BG between 3-3.9 mmol without cause (e.g. missed meal)
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18
Q

Dose Reduction after Hypoglycaemia

Insulin

A
  • do not omit next dose if Type 1 DM –> May reduce

- next dose may be omitted if T2DM with review from DM team.

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19
Q

Quick Acting Insulin

A
  • usually given with meals (3x daily)
  • not given at bedtime
  • Short acting insulin - Actrapid and Humulin S. Peak at 2 hours
  • rapid acting insulin analogues (genetically engineered, usually quicker than short acting insulin) Humalog and Novarapid. Peak at 15 mins
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20
Q

Medium or Long Acting Insulin

A
  • usually given twice a day (morning and bed time)
  • medium acting insulins - Humulin I and Insulatard
  • long acting insulin analogues - Lantus and Levemir
21
Q

Insulin Mixtures

A

Normally BD. Provide basal and meal time coverage. Never given before bed. Sometimes OD in the elderly.

  • Premixed Insulins e.g. Humulin M3 - give 15-20 mins before a meal
  • Biphasic Analogue Mixtures e.g Novomix30 or Humalog Mix25 - with or 15mins after carbs
22
Q

Multiple Injection Insulin Regime

A

quick acting insulin with each meal
1-2 background long acting insulin

T1DM, some T2DM

23
Q

Twice Daily Insulin Regime

A

Insulin mixtures. T2DM

24
Q

Once Daily Insulin Regime

A

Medium/long acting insulin at bedtime, plus oral hypoglycaemics in T2DM.

Occasionally elderly pts long acting/mixture in the morning

25
Q

Insulin pumps

A
  • if Hypoglycaemic treat with IV insulin- pump may be broken

- if pump is disconnected at risk of DKA very quickly- give SC insulin

26
Q

DAFNE

A

Dose Adjustment For Normal Eating

  • pre-meal/snack short acting, BD medium acting
  • estimate carb content of food
  • calculate insulin requirements of food
  • should be able to self manage
  • should still record doses and monitoring of self managing pts.
27
Q

Metformin

A

Doesn’t make patients gain weight
Biguanide
Favourable action on lipids, anti-cancer and cardio-protective
Impaired renal function - lactic acidosis in eGFR < 30, diarrhoea and abdominal discomfort

28
Q

Sulphonylureas

A

gliclazide
- stimulate insulin release by binding to B-cell receptors
improves glycaemic control at the significant weight gain
doesnt prevent gradula failure of insulin secretion
can cause hypoglycaemia- occasionally prolonged and fatal- especially in elderly and renally impaired.

29
Q

Thiazolidinediones

A 
pioglitazone
- activates genes that promote gluocse uptake and utilisation and lipid metabolism
improve insulin sensitivity 
need insulin fro a therapeutic effect
relatively rare
30
Q

Thiazolidinediones

Side Effects

A 
Weight gain
macular oedema
Oedema
Heart Failure
Increased fracture risk
31
Q

Incretin concept

A

Enteral glucose

32
Q

Effects of GLP-1

A 
stimulates insulin secretion 
suppresses glucagon secretion 
slows gastric emptying
reduces food intake
rapidly degraded
33
Q

Therapeutic effect of GLP-1 in T@DM

A

reduces energy intake, blood glucose

34
Q

SGLT2 inhibitors

A

Block reabsorption of glucose in the kidney, increase glucose excretion and lower blood glucose levels
e.g. empagliflozin, canaglioflozin, dapagliflozin
may benefit CV mortality

35
Q

SGLT2 inhibitor

Side Effects

A

genital thrush

increased risk of euglycaemic ketoacidosis

36
Q

Bed time insulin

A

Long acting- maintains liver secretion over night

Combination of bedtime background insulin (NPH) and oral agents

37
Q

weight gain in insulin therapy

A
  • decrease in energy loss as glucosuria ceases and is not compensated for by comparable reduction in energy intake
  • ? increase in appetite with an anabolic hormone
38
Q

bariatric surgery

A

can produce profound weight loss and may also alter secretion of incretin hormones
- gastric anding/ gastric bypass
can cure T2DM in up to 70% even in those treated with insulin

39
Q

DKA

A 
raised BG
metabolic acidosis (Bicarb <16, pH<7.3)
Blood ketones>3mmol / ketonuria >++/4mmol/40mg/l
40
Q

Causes of DKA

A

older age groups- infection

<30 omission of insulin

41
Q

Mortality of DKA

A

5-10% lower in specialist centres
causes
- elderly- comorbidities and late presentation
-vomiting - 12-24 hours to live without treatment

42
Q

DKA treatment

A
  1. restore circulating blood volume
  2. Replace lost electrolytes
  3. Return blood glucose towards normal while giving sufficient insulin to inhibit hepatic gluconeogeneis
43
Q

DKA teatment

A 
1l saline in first hour 
1 l in next 2 
1l in next 4 
1l in next 6
- reduce in elderly or in cardiac disease
44
Q

DKA potassium

A

normal or high serum potassium but low total potassium
add potassium to the IV when plasma potassium is known
>5.5

45
Q

DKA insulin

A

0.1 unit/kg/hr
double concentration if insulin resistant
monitor glucose hourly
keep high- when BG <14 add glucose to NaCl
Target blood glucose is between 8-14 mmol

46
Q

Other measures of DKA

A
  • SpR DM
    -Urinary catheter
    -EWS
    -NG–> HDU
    commence prophylactic anticoagulation
    Dont give bicarb
47
Q

Hyperosmolar Hyperglycaemic State

A

hypovolaemia

hyperglycaemia >30mmol

48
Q

HHS

A 
T2DM
High mortality
Sodium increases
normal saline, anticoagulants
manage with sulphylureas
Don't use insulin routinely
slow and steady- prevent rapid fluid shifts
treat underlying cause if infection

3B General Care (8 decks)

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