Hyper and Hypoglycaemia

Question 1

list 6 symptoms of diabetes

Answer 1

Thirst
 Frequent urination especially at night
 Tiredness
 Sudden change in weight: weight loss
 Genital itching and frequent thrush
 Blurred vision

Question 2

in which 2 ways can diabetes be diagnosed

Answer 2

Blood glucose level

Oral glucose tolerance test

Question 3

what value is classed as high after doing a Oral glucose tolerance test and how is it done

Answer 3

anything above 11.1 mmol for someone with diabetes
anything below 11.1 mmol if a patient doesn’t have diabetes

always performed 8-12 hours after fasting. Px will then drink a high concentration of glucose solution and the blood is then tested 2 hours later

Question 4

name the 4 types of diabetes

Answer 4

Impaired glucose tolerance
Gestational diabetes
Type 1 diabetes mellitus
Type 2 diabetes mellitus

Question 5

what can Impaired glucose tolerance result in

Answer 5

higher rate of cardiovascular death

Might develop diabetes mellitus

Question 6

when does Gestational diabetes usually develop and what causes the diabetes

Answer 6

Develops during or after pregnancy

Pregnancy hormones can block insulin

Question 7

which 2 ways can you improve diabetes control

Answer 7

Diet and exercise
  Type 1 diabetes: life depends on insulin injections
  Type 2 diabetes: add tablets to diet and exercise regime. If
necessary add insulin injection

  Manage BP and blood lipids appropriately

Question 8

name 2 acute complications of diabetes

Answer 8

Hypoglycaemia and Hyperglycaemia

Question 9

list 4 chronic Microvascular complications

Answer 9

Retinopathy (eye)

Nephropathy (kidney disease)

Neuropathy (small nerve disease)

Autonomic neuropathy (peripheral nerves) - damage to nerves that regulate bp, heart rate, bladder emptying, digestion

Question 10

name 3 chronic macrovascular complications

Answer 10

Coronary artery disease
strokes
amputations

Question 11

where is insulin made from and what is the purpose of it

Answer 11

the pancreas

insulin is needed to transport glucose (a simple sugar from our diet) to the cells of our body

Insulin transports glucose from blood into cells

Question 12

what is hyperglycaemia and what value is it classified as

Answer 12

Too much glucose in the bloodstream
Occurs when blood glucose levels are not strictly controlled

Blood glucose level of 10+ mmol/l

Question 13

what is a normal value of blood glucose

Answer 13

Normal 4 to 6 mmol/l

Question 14

when do the symptoms of hyperglycaemia usually become noticeable

Answer 14

until there is a blood glucose level of 15-20+ mmol/l

Question 15

what is ketoacidosis and how can it be dangerous

Answer 15

Not enough insulin to move glucose into cells: fat is used as a fuel source = high levels of ketones

Breakdown of fats: ketones build up in the blood and urine (poisonous)

Question 16

what should be done if you suspect a person has ketoacidosis

Answer 16

Urine test should be performed every 4-6 hours anytime a person with DM is:
  Registering blood sugar above 12mmol/l
  Sick
  Unusually thirsty or has a dry mouth
  Urinating frequently
  Vomited

Question 17

name 5 signs/symptoms a person may have if they are suffering from ketoacidosis

Answer 17

Registering blood sugar above 12mmol/l
Sick
Unusually thirsty or has a dry mouth
Urinating frequently
Vomited

Question 18

name 6 warning signs that ketoacidosis is getting serious

Answer 18

Flushed face
Dry skin and mouth
Nausea or vomiting
Stomach pain
Deep, rapid breathing
Fruity breath odour 

send this person to A&E - if untreated, can lead to a coma or death

Question 19

what blood sugar level is classed as hypoglycaemic

Answer 19

BGLs <4 mmol/L

Question 20

what is released as a warning sign of hypo and what is the end result of a hypo attack

Answer 20

ADRENALIN is released and it is responsible for the warning signs of a hypo

End-result of a hypo: brain does not get enough sugar, so it cannot function, the patient could die

Question 21

list 5 causes of hypoglycaemia

Answer 21

Too much insulin / too many tablets
Delayed or missed meals or snacks
Not enough food (especially carbohydrate)
Unplanned or strenuous exercise
Drinking alcohol without food
No obvious cause

Question 22

list the 9 diabetes medications that can cause a higher risk of hypoglycaemia

Answer 22

Insulin 
Sulphonylureas
Glipizide
Gliclazide
Chlorpopamide
Gliquidone
Glimerpiride
Tolbutamide
Repaglinide

Question 23

name a medication that is unlikely to cause a hypo

Answer 23

metformin

Question 24

what should people who are on arcarbose always be given and why

Answer 24

always be given sg like Lucosade as the absorption (release?) of glucose is very slow

Question 25

what 2 types of medications used to treat other conditions risk modifying the action of tablets for diabetes

Answer 25

antibiotics

anti depressants

Question 26

which type of diabetic patient is hypo more common in and why

Answer 26

type 1 DM

The better the diabetes control the more common the hypo is

Requires careful balance between insulin – food - exercise
hence have to calculate exact intake of food esp carbs and amount of insulin injected

Question 27

list 5 types of mild hypo symptoms that are treatable

Answer 27

Hungry

Trembling and sweating

Irritable, aggressive, unreasonable

Pale, fast pulse, tingling of the limps

Blurring vision

Question 28

how must you treat a mild hypo

Answer 28

Immediate: quick carbohydrate: fruit juice, coke, glucose tablets,
sugar, chocolate

Long acting: sandwich, biscuits, cereal, fruit

Question 29

list 4 signs of a severe hypo

Answer 29

Difficulty in concentrating

Confused and vague

Irritable and irrational

Loss of consciousness, fits and coma

Question 30

what is the treatment of severe hypo if someone is conscious

Answer 30

Hypostop (sugar gel), honey, treacle or jam (2-3 teaspoons) inside the mouth, once the px is better, follow up as per mild hypo

Question 31

if a person is suffering from hypo and is unconscious - how are they treated

Answer 31

if you are trained use Hypostop etc; if not, place the px in the recovery position and GET HELP!

Glucagon or iv glucose should only be given by trained
personnel