Inpatient diabetes - Getting the basics right Flashcards
20% of inpatients will have diabetes but only a few are inpatients because of their diabetes - most are there because of operations, illnesses etc that are not directly linked to their diabetes, but why is it bad if it was not recognised they have diabetes ?
It can result in problems as heir diabetes could affect the illness or operation
How could an admission to hospital affect a patients normal diabetes management ?
- Patients eat less in hospital as unwell or eat different foods (less carbs) which could = hypoglycaemia
- Also if they are vomiting or being told to fast (e.g. for an op and management isn’t adjusted) could = hypoglycaemia
- Diabetes medicines given in the wrong way or time could = hypoglycaemia
- Hormonal effects and stress of the illness can = hyperglycaemia
High glucose levels slow the healing process - T/F?
True
When identifying diabetes in new admission what saying is used to best treat the patient and ensure the reason they are in doesn’t affect their diabetes ?
Think - how the patients illness/reason for being admitted may affect their diabetes
Check - what monitoring/medication changes are required
Act - on results to reduce chances of hypo or hyperglycaemic episode or foot problems
How can you identify diabetes in a patient on admission?
- Listen to patient/past med history
- Monitor blood glucose as part of routine assessment for patient admitted with acute illness
- Monitor blood glucose for patients on steroids or total parenteral nutrition
Which patients should always be referred to the diabetes specialist team?
- New diagnosis of type 1 diabetes
- Complications of diabetes e.g. autonomic neuropathy
- Poor blood glucose control
- Patients who require insulin initiation
- Diabetes and pregnancy
- DKA (diabetic ketoacidosis)
- Hyperglycaemic hyperosmolar state
- Recurrent or severe hypoglycaemia
Refer within 24hrs
List patients who may require referral to diabetes specialist team or you may need to ask for advice on treatment
- Sepsis
- Vomiting
- Acute coronary syndrome
- parenteral or enteral feeding
- Treatment with corticosteroids
- IV insulin use for >48 hrs
- Using subcutaneous insulin infusion pumps
What mnemonic do you follow for feet in diabetic patients
CPR:
Check - patients with diabetes for foot ulcers and assess there risk for developing them
Protect - patients at risk by applying pressure relieving devices
Refer - active foot problems to appropriate specialist
Which diabetic patients have at risk feet?
- Patients with neuropathy
- Those who’ve had previous ulcer or amputation
- Those who are bed bound or have fragile skin
Blood glucose monitoring is essential to assess how effective diabetic management is what are the general blood glucose levels which are acceptable in the inpatient setting ?
6-12 mmol/L some patients this is not the case
Should patients with diabetes and who are acutely unwell have their blood glucose levels checked on admission?
Yes
How often should blood glucose be measured in patients receiving subcutaneous insulin and IV insulin
Monitored before each subcutaneous injection
Monitored hourly during IV insulin
In the event of hypoglycaemia when should blood glucose be measured?
15 mins after treatment to see if its worked or further treatment is needed
How often should patients on sulphonylureas (gliclazide/ glypizide) have glucose levels checked?
2x’s daily
How often should blood glucose be checked in patients clinically well treated with diet alone or metaformin ?
less often e.g. maybe once per day before a meal
