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2 Endocrine > Diabetes LDAP Modules > Flashcards

Diabetes LDAP Modules Flashcards

1
Q

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

A

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

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2
Q

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

A

stress and hormonal effects of illness

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3
Q

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

A

high

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4
Q

what non-diabetic treatments should you monitor BGL for?

A

total parenteral nutrition

steroids

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5
Q

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

A 
newly diagnose T1DM
diabetics with complications
poor glycaemic control
pregnant diabetics
DKA
HHS
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6
Q

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

A

within 24hrs

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7
Q

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

A 
sepsis
vomitjng
ACS
parenteral/enteral feeding
steroid
IV insulin >48hrs
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8
Q

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

A 
bed bound
neuropathy patients
previous ulcer
amputees
fragile skin
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9
Q

what does CPR of the feet mean?

A

check
protect
refer

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10
Q

which BGL ranges are desirable for an inpatient?

A

6-10mmol/l

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11
Q

when should you recheck BGL in hypoglycaemia?

A

every 15 mins after treatment

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12
Q

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

A

before each injection

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13
Q

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

A

hourly

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14
Q

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

A

twice daily

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15
Q

how often should an unwell patient have their glucose checked?

A

4x daily

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16
Q

most common regions for subcutaneous insulin administration?

A

abdomen
upper outer thigh
upper outer arm
buttock

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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

what happens if you inject too deeply?

A

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

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20
Q

what insulin concentration is most commonly used in hospitals?

A

100 units per ml

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21
Q

what insulin syringe should be used when giving insulin?

A

1ml

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22
Q

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

A

unopened vials and pens

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23
Q

what has to be done before injecting the patient?

A

document the insulin prescription on drug prescription and insulin charts

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24
Q

why shouldnt you note “units” as u?

A

can be misinterpreted as 0 so can increase dose tenfold

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25
Q

what diabetes medications cause hypos?

A 
4 G's
gliclazide
glibenclamide
glipizide
glimepiride
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26
Q

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

A

glycogen is low

27
Q

what causes low glycogen in T1DM?

A

frequent hypos
malnourished
severe liver disease
consumed alcohol to excess

28
Q

autonomic symptoms of hypo?

A 
trembling
anxiety
palpitations
numbness
irritated
hungry
pale/sweaty
nervous
29
Q

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

A

2mmol/l

30
Q

neurological symptoms of hypoglycaemia?

A 
problems with weakness, concentration and coordination
slurred speech
vision problems
seizures
coma
31
Q

first line treatment for hypos in patients who can swallow?

A

15-20g of carbohydrate

32
Q

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

A

1.5-2 tubes of glucose gel

33
Q

how is glucose gel absorbed

A

via buccal mucosa

34
Q

how should you manage an unconscious patient in hypo?

A

ABC
IV glucose
S/C or IM glucagon

35
Q

how long should IV glucose be infused?

A

10-15mins

36
Q

what volume of 20% glucose should be given?

A

75ml

37
Q

what volume of 10% glucose should be given?

A

150ml

38
Q

how can glucagon be administered?

A

S/C
IM
IV

39
Q

adult dose for glucagon?

A

1mg

40
Q

child’s dose for glucagon?

A

500mcg

41
Q

what should be done after treating the hypo?

A

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

if cant: IV glucose

42
Q

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

A

hypo box

43
Q

what should quick acting insulins always be given with?

A

carbohydrate

44
Q

how long do soluble insulins take to work?

A

30mins

45
Q

how long do rapid acting insulin analogues take to work?

A

immediate

46
Q

when should you inject a soluble insulin and why?

A

30mins before eating as it takes this long to work

47
Q

what is fixed mix insulin?

A

insulin containing both rapid acting and long acting insulin

48
Q

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

A

the percentage of short acting insulin

49
Q

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

A

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

50
Q

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

A

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

51
Q

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

A

increase breakfast insulin dose

52
Q

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

A

increase dinner insulin dose

53
Q

how much should you increase/decrease of insulin by?

A

10%

54
Q

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

A

decrease basal insulin dose

55
Q

should you omit insulin in hypo?

A

no

56
Q

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

A

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

57
Q

what can prolonged IV insulin use cause?

A

infection from cannula

electrolyte abnormalities eg hyponatraemia

58
Q

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

A

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

59
Q

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

A

IV insulin

long acting basal SC injection

60
Q

what does an anti-syphon valve do?

A

avoid free flow of insulin from syringe driver

61
Q

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

A

mealtime dose

62
Q

when should you switch to SC insulin from IV?

A

when the patient is stable and is eating/drinking well

at a mealtime

63
Q

when should you stop IV insulin after starting SC insulin?

A

30-60mins

64
Q

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

A

restart oral meds at meal

stop IV after 1 hr

2 Endocrine (35 decks)

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