Diabetes LDAP Modules

Question 1

what can cause low BGL’s in in-patient diabetics?

Answer 1

eating less
changing the food they eat eg less carb
fasting for surgery
vomiting

Question 2

what can cause high BGL’s in an in-patient diabetic?

Answer 2

stress and hormonal effects of illness

Question 3

do high or low glucose levels slow the healing process of a sick person?

Answer 3

high

Question 4

what non-diabetic treatments should you monitor BGL for?

Answer 4

total parenteral nutrition

steroids

Question 5

what diabetic patients should always be referred to the diabetes team?

Answer 5

newly diagnose T1DM
diabetics with complications
poor glycaemic control
pregnant diabetics
DKA
HHS

Question 6

within which time frame should the appropriate patients be referred to the diabetic team?

Answer 6

within 24hrs

Question 7

when should you consider altering the dose of diabetes treatment you’re giving in hospital?

Answer 7

sepsis
vomitjng
ACS
parenteral/enteral feeding
steroid
IV insulin >48hrs

Question 8

whose feet are particularly at risk of a diabetic foot ulcer?

Answer 8

bed bound
neuropathy patients
previous ulcer
amputees
fragile skin

Question 9

what does CPR of the feet mean?

Answer 9

check
protect
refer

Question 10

which BGL ranges are desirable for an inpatient?

Answer 10

6-10mmol/l

Question 11

when should you recheck BGL in hypoglycaemia?

Answer 11

every 15 mins after treatment

Question 12

when should you test patients’ BGLs who are receiving subcutaneous insulin?

Answer 12

before each injection

Question 13

when should you measure a patient under IV insulin’s BGL?

Answer 13

hourly

Question 14

how often should a patient on SUR have their glucose checked?

Answer 14

twice daily

Question 15

how often should an unwell patient have their glucose checked?

Answer 15

4x daily

Question 16

most common regions for subcutaneous insulin administration?

Answer 16

abdomen
upper outer thigh
upper outer arm
buttock

Question 17

should you inject the same site when you take your insulin?

Answer 17

no, inject a different site at different times of the day

Question 18

does it matter which type of insulin goes into which injection site?

Answer 18

yes, you should inject the same insulin to the same injection site

Question 19

what happens if you inject too deeply?

Answer 19

will hit muscle and insulin will go directly into bloodstream causing hypo

Question 20

what insulin concentration is most commonly used in hospitals?

Answer 20

100 units per ml

Question 21

what insulin syringe should be used when giving insulin?

Answer 21

1ml

Question 22

what are the only insulin supplies that should be stored in the fridge?

Answer 22

unopened vials and pens

Question 23

what has to be done before injecting the patient?

Answer 23

document the insulin prescription on drug prescription and insulin charts

Question 24

why shouldnt you note “units” as u?

Answer 24

can be misinterpreted as 0 so can increase dose tenfold

Question 25

what diabetes medications cause hypos?

Answer 25

``` 4 G's gliclazide glibenclamide glipizide glimepiride ```

Question 26

why don't the counter regulatory hormones bring the body back from hypo?

Answer 26

glycogen is low

Question 27

what causes low glycogen in T1DM?

Answer 27

frequent hypos malnourished severe liver disease consumed alcohol to excess

Question 28

autonomic symptoms of hypo?

Answer 28

``` trembling anxiety palpitations numbness irritated hungry pale/sweaty nervous ```

Question 29

at what BGL does the brain become impaired from lack of glucose?

Answer 29

2mmol/l

Question 30

neurological symptoms of hypoglycaemia?

Answer 30

``` problems with weakness, concentration and coordination slurred speech vision problems seizures coma ```

Question 31

first line treatment for hypos in patients who can swallow?

Answer 31

15-20g of carbohydrate

Question 32

what should be given to patients in hypo who are drowsy or confused?

Answer 32

1.5-2 tubes of glucose gel

Question 33

how is glucose gel absorbed

Answer 33

via buccal mucosa

Question 34

how should you manage an unconscious patient in hypo?

Answer 34

ABC IV glucose S/C or IM glucagon

Question 35

how long should IV glucose be infused?

Answer 35

10-15mins

Question 36

what volume of 20% glucose should be given?

Answer 36

75ml

Question 37

what volume of 10% glucose should be given?

Answer 37

150ml

Question 38

how can glucagon be administered?

Answer 38

S/C IM IV

Question 39

adult dose for glucagon?

Answer 39

1mg

Question 40

child's dose for glucagon?

Answer 40

500mcg

Question 41

what should be done after treating the hypo?

Answer 41

if can swallow: give 20mg of a more complex carb eg bread if cant: IV glucose

Question 42

what tool can be used for treating hypoglycaemia anywhere in the hospital?

Answer 42

hypo box

Question 43

what should quick acting insulins always be given with?

Answer 43

carbohydrate

Question 44

how long do soluble insulins take to work?

Answer 44

30mins

Question 45

how long do rapid acting insulin analogues take to work?

Answer 45

immediate

Question 46

when should you inject a soluble insulin and why?

Answer 46

30mins before eating as it takes this long to work

Question 47

what is fixed mix insulin?

Answer 47

insulin containing both rapid acting and long acting insulin

Question 48

what is the number in some fixed mix insulin's drug names? eg Humalog Mx 50?

Answer 48

the percentage of short acting insulin

Question 49

what happens if you give humalog in place of humalog mix 25?

Answer 49

hypo as it has 100% quick acting insulin and no long term cover

Question 50

should you do the basal bolus regimen 3x per day even if you're eating a carb free lunch?

Answer 50

no, dont take bolus if you havent eaten carbs at a meal

Question 51

what should you do if BGLs are high before lunch and dinner in someone who has twice daily injections?

Answer 51

increase breakfast insulin dose

Question 52

what should you do if BGLs are high before bed and before breakfast in someone who has twice daily injections?

Answer 52

increase dinner insulin dose

Question 53

how much should you increase/decrease of insulin by?

Answer 53

10%

Question 54

if the patient is hypo at breakfast what should you do?

Answer 54

decrease basal insulin dose

Question 55

should you omit insulin in hypo?

Answer 55

no

Question 56

what is IV insulin's half life? why is this relevant

Answer 56

5 mins; if not administered properly the insulin will not take effect and patient can go hyperglycaemic

Question 57

what can prolonged IV insulin use cause?

Answer 57

infection from cannula | electrolyte abnormalities eg hyponatraemia

Question 58

what should you put in the insulin syringe for IV administration?

Answer 58

50 units of soluble insulin and 49.5ml of 0.9% NaCl

Question 59

what should patients on multiple daily insulin doses take when they have DKA?

Answer 59

IV insulin | long acting basal SC injection

Question 60

what does an anti-syphon valve do?

Answer 60

avoid free flow of insulin from syringe driver

Question 61

what insulin dose that is usually taken is missed on IV insulin?

Answer 61

mealtime dose

Question 62

when should you switch to SC insulin from IV?

Answer 62

when the patient is stable and is eating/drinking well | at a mealtime

Question 63

when should you stop IV insulin after starting SC insulin?

Answer 63

30-60mins

Question 64

when should you switch to oral diabetes medication from IV insulin?

Answer 64

restart oral meds at meal | stop IV after 1 hr