Inpatient Diabetes Flashcards
what is the prevalence of diabetes within inpatients in Scotland
up to 20% of inpatients
describe the different ways hypoglycaemia can occur in a diabetes inpatient if there diabetes isn’t recognised
patient eats less in hospital as they are unwell, change in type of food(eg less carbs), if vomiting, being told to fast, if diabetes medicine administered in wrong or at wrong time
describe how hyperglycaemia can occur in a diabetes inpatient if there diabetes isn’t recognised
hormonal effects and stress of illness can increase blood glucose
describe why hyperglycaemia is bad for patients trying to recover from illness
it slows the healing process and increases susceptibility to infection
in what ways can you identify presence or risk of diabetes on hospital admission
listen to patient, take appropriate PMH, monitor blood glucose on admission as routine for acute illness, monitor blood glucose for those prescribed steroids or TPN
what patients must always be referred to a specialised diabetes team within 24 hours of admission (8)
new type 1 diabetics, complications of diabetes, poor glucose control, require insulin initiation, if diabetic + pregnant, diabetic ketoacidosis(DKA), HHS, recurrent/sever hypoglycaemia
what does HHS stand for
hyperglycaemic hyperosmolar state(HHS)
give some examples of scenarios that may require a patient to be referred to a specialised diabetes team to alter medication
sepsis, vomiting, ACS, treatment with corticosteroid
what does CPR stand for
check, protect, refer
describe what CPR for feet in patients with diabetes involves
C = existing foot ulcers/risk of developing them P = those at risk by applying pressure-relieving devices appropriate to needs R = active foot problems to appropriate specialist
what indications suggest a diabetic patient has high-risk feet
neuropathy, previous ulcer or amputation, those who are bed bound or have fragile skin
what are the general desirable and acceptable blood glucose levels in an inpatient setting
desirable = 6-10mmol/L
acceptable = 4-12mmol/L
(not used for everyone)
when should blood glucose be tested on hospital admission
in diabetics and those who are acutely unwell
when should patients being treated with insulin have their blood glucose tested
before each injection if subcutaneous insulin, and hourly during IV insulin
when should blood glucose be tested when treating hypoglycaemia
15 mins after treatment
