Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Hypoglycaemia > Flashcards

Hypoglycaemia Flashcards

1
Q

What are the symptoms of hypoglycaemia?

A
  • Difficulty concentration
  • Confusion, unconsciousness
  • Change of behaviour
  • Slurring of speech & convulsions
  • Shaking & trembling
  • Sweating
  • Pin & needles in lips n tongue
  • Hunger
  • Palpitation
  • Headache (occasionally)
  • Double vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What drug is most likely to cause hypoglycaemia?

A
  • Sulphonylurea
  • Insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Explain the management for hypoglycaemia?

A

Blood glucose is over 4mmol/l with hypo symptoms - have a small carb snack like bread/normal meal

If blood glucose is less than 4mmol/l with/without symptoms; and conscious and can swallow - give oral glucose e.g. glucogel

After 30-45 minutes or 3 cycles:

If blood glucose is less than 4mmol/l and still conscious - give IM glucagon or IV glucose 10% infusion (and thiamine if alcoholic patient)

If no better, it’s an emergency

if glucose levels is still less than 4mmol/l and unconscious - give IM glucagon or IV glucose 10% / 20% infusion

(if glucagon is not effective after 10 minutes (or is unsuitable) then give IV glucose 10% / IV 20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What’s an alterantive to glucogel, that you can give to patients with 4mmol/l or less, with or without symptoms?

A
  • Glucose liquid
  • Glucose tablets
  • Dextrogel
  • Pure fruit
  • Dissolved sugar (sucose)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which patients cannot take sucrose?

A

Patients taking acarbose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which patients should not take orange juice?

A

Patients following a low potassium diet due to chronic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why are chocolates and biscuits not given for hypoglycaemia?

A

Because they have a low sugar content, and high fat content can delay gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain the three cycles you can do for hypoglycaemia?

A

Eat, wait 15 mins.
Repeat for a max of 3 times in total.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should be done after glucose concentration is over 4mmol/l?

A

A snack containing a long acting carb should be given.

Or a normal carb containing meal, if due

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is an example of a long acting carb?

A
  • Two biscuits
  • One slice of bread
  • 200-300ml of milk (not soya or alternatives)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should glucagon be avoided?

A
  • Prolonged fasting
  • Adrenal insufficiency
  • Chronic hypoglycaemia
  • Alcohol-induced hypoglycaemia
  • In patient taking Sulfonylurea, give IV glucose instead
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can be given to patients to due the CV risk?

A

ACE inhibitor, low dose aspirin & lipid regulating drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should be done to diabetic patients to prevent nephropathy?

A

BP should be reduced to lowest level, to prevent decline of glomerular filtration rate and reduce proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What test must be done for nephropathy?

A

Test for urinary protein and serum creatinine.

If test is negative, test urine for microalbuminuria (early sign of nephropathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What must all patients with nephropathy be given?

A

Must be given ACEi or ARB, if not contra-indicated; even if BP is normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which diabetic patients should be given ACEi?

A

Given to patients with CKD and proteinuria, to reduce progression of CKD

17
Q

What painkillers can be used with neuropathy complications with diabetic patients?

A
  • Duloxetine, venlafaxine can be used for pain.
  • Amitriptyline and imipramine can be used as alternatives
  • Pregabalin and gabapentin can tried, if all above are ineffective
  • Opioid analgesics (such as tramadol, morphine, oxycodone) can be used in combination with pregabalin

For autonomic neuropathy - codeine, tetracycline & erythromycin

18
Q

What are the signs and symptoms of Diabetic Ketoacidosis (DKA)?

A
  • Dehydration due to polydipsia & polyuria
  • Weight loss
  • Excessive tiredness
  • Nausea & vomiting
  • Abdominal pain
  • Rapid n deep respiration
  • Sweet smell to breath (acetone breath)
  • Reduced consciousness
  • Sweet or metallic taste
  • Different odour to urine or sweat
19
Q

What is Hyperosmolar hyperglycaemic state (HHS)?

A

Very high blood sugar levels in people with type 2 diabetes that has or hasn’t been diagnosed and can be caused by illness and dehydration

20
Q

What are the signs and symptoms of Hyperosmolar hyperglycaemic state (HHS)?

A
  • Dehydration due to polydipsia & polyuria
  • Weight loss
  • Weakness
  • Tachycardia
  • Hypotension
  • Poor skin turgor
  • Acute cognitive impairment
  • Shock (in severe cases)
21
Q

What are the treatments for HHS?

A

IV fluid replacement, followed by IV insulin

K+ omitted or replaced if required

  • Same as the treatment for DKA but no glucose at the dance
22
Q

What does the management of DKA involve?

A

It involves fluid + electrolytes + insulin

  • Sodium/potassium chloride 0.9% IV infusion, if systolic BP is less than 90mmHg for 10-15 mins. Repeat if BP is still low and seek medical advice
  • Mix sodium chloride 0.9% with a soluble insulin, in an infusion to a concentration of 1unit/ml, infuse at a fixed rate of 0.1units/kg/hr.
23
Q

What must be monitored for DKA management?

A

Monitor blood glucose and blood ketone hourly

24
Q

What should be continued during DKA managment?

A

Continue long acting analogues (detemir & glargine), during DKA treatment.

25
Q

What is the management of diabetes during surgery?

A

All patients should have emergency treatment for hypoglycaemia written on drug chart and on admission

26
Q

What is the management of insulin during surgery?

A
  • Adjust insulin according to patients.
  • On day before surgery, give insulin as normal (except long acting once daily insulins, which should be given as a reduced dose. Reduced by 20%)
  • One day of surgery, you stop taking all other insulins and continue 80% long acting, until the patient is eating and drinking again after surgery.
27
Q

During surgery, which drugs must be stopped once insulin infusion is commenced? When should they be restarted?

A
  • Acarbose
  • Sulfonylureas
  • Pioglitazone
  • Meglitinides
  • SLGT2i
  • Gliptins

They are not restarted until the patient is eating and drinking normally

28
Q

Which drugs can be continued once insulin infusion has commenced during surgery?

A
  • Metformin
  • GLP-1 agonist
29
Q

Which drug can be used during contrast medium (medical imaging)?

A

Metformin

30
Q

Go back to hypoglycaemia video - 37 mins

A

.

31
Q

What complication can happen during diabetes in pregnancy?

A
  • Pre-eclampsia
  • Retinopathy
  • Congenital malformations
  • Can effect fetal development
32
Q

What must be given to diabetic patients planning to get pregnant?

A

Folic acid 5mg

33
Q

What concentration for HBA1c be in pregnancy?

A

Less than 49mmol/mol

34
Q

Which drugs can be used during pregnancy?

A

Metformin is the ONLY oral anti diabetic drug that can be used during pregnancy.
Others must be stopped before pregnancy, or as soon as unplanned pregnancy is identified.

Oral drugs must be replaced with insulin

35
Q

Can metformin be given to breastfeeding patients?

A

Yes, it can given to breastfeeding patients

36
Q

Which insulins should be given during pregnancy?

A

Long acting / medium acting:
- Isophane insulin (1st choice)
- Detemir or glargine (only if the patient was already on this and have good blood-glucose control before pregnancy)

Rapid acting - because fewer episodes of hypo
- Aspart
- Lispro

37
Q

When is the risk of hypo highest in pregnancy when using insulin? What advice must be given to patients?

A
  • Highest risk during 1st trimester

Therefore glucagon should be prescribed for type 1 diabetic patients

Advice patients to carry glucose/dextrose/glucose drink

38
Q

What other drugs must be discontinued during pregnancy for diabetic patients?

A

Discontinue ACEi / ARB and replace with methyldopa or labetolol in pregnancy

Discontinue statin

39
Q

What are the steps for Gestational diabetes?

A

Step 1 - diet and exercise alone
Step 2 - Metformin
Step 3 - Add insulin if metformin is ineffective

Endocrine (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions