diabetes mellitus type 2 guidelines - medical emergency

Question 1

when can you use the rule of 15 to manage hypoglycaemia in t2dm (3)

Answer 1

• awake
• alert
• can swallow

Question 2

rule of 15 to manage confirmed hypoglycaemia in t2dm (5)

Answer 2

• keep patient seated and secure so they can’t fall over
• give 15g of quick acting carbohydrates
• repeat BSL at 15 minutes
• if not increasing, another 15g quick acting carbohydrates
• provide longer acting carbs if next meal is >15mins away (sandwich, glass of milk, a piece of fruit)
• test glucose every 1-2 hours for next 4 hours

Question 3

examples that will give 15g quick acting carbs (5)

Answer 3

6-7 jellybeans
1/2 can soft drink
1/2 glass fruit juice
3 tsp honey / sugar
3 glucose tablets

Question 4

rule of 15 to manage unconfirmed hypoglycaemia (2)

Answer 4

• administer 15g quick acting carbohydrates

- if no improvement at 15 minutes, get medical review

Question 5

t2dm - management of severe hypoglycaemia (6)

Answer 5

• call 000, cite ‘diabetic emergency’
• resuscitation room
• glucagon 1mg IM to thigh stat
• IV access
• IV glucose 50%, 20mL via cannula
• recheck BGL 15 mins after glucagon

Question 6

t2dm - medications that can cause hypoglycaemia

Answer 6

insulin

sulfonylureas - gliclazide, glibenclamide

Question 7

t2dm - causes of hypoglycaemia (5)

Answer 7

not enough carb intake

increased exercise
increased alcohol intake

renal impairment

medication - insulin, sulfonylureas

Question 8

t2dm - definition of hypoglycaemia

Answer 8

BGL <= 3.9mmol/L
and/or
BGL low enough to trigger glycopenic or neuroglypenic symptoms and signs

Question 9

hypoglycaemia - glycopaenic symptoms (6)

Answer 9

pale skin
sweating

shaking
palpitations

anxiety
dizziness

Question 10

hypoglycaemia - neuroglycopaenic symptoms (6)

Answer 10

hunger
change in intellectual processing
confusion
paraesthesia
seizure
coma

Question 11

t2dm - define asymptomatic hypoglycaemia

Answer 11

BGL <= 3.9, no symptoms

Question 12

t2dm - define severe hypoglycaemia

Answer 12

hypoglycaemia requiring someone else to help treat

Question 13

t2dm - biochemical criteria for DKA

Answer 13

hyperglycaemia >= 11.1mmol/L
venous pH < 7.3 or HCO3 < 15mmol/L
blood or urinary ketones >= 0.6mmol/L