Management of Diabetes C - Type 1 Diabetes Mellitus Flashcards
what health care specialist are involved in managing a patient with diabetes
DNS practice nurse dietitian podiatrist doctor
what are the 4 things to check before injecting insulin
right insulin
right dose
right time
right way
if blood ketones are less than 0.6mmol/l what should be done
repeat test after 2 hours to check levels arent rising
if blood ketones are higher than 0.6 mmol/l what should be done
- drink plenty of fluids
- correction dose of insulin
- retest blood sugar and ketones in 1-2 hours
what is the most important thing to give when ketone levels are rising
give extra insulin
why does insulin have to be given subcutaneously or via IV
as it is a polypeptide it is inactivate by the GI tract
what is the insulin regime for injecting twice daily
RAI & IAI before breakfast and before evening meal
what is the insulin regime for injecting three times daily
- RAI & IAI before breakfast
- RAI before evening meal
- IAI at bedtime
what is the insulin regime for injecting four times daily
SAI before breakfast, lunch, evening meal
IAI at bedtime
what is hypoglycaemia
any episode of low blood glucose with or without symptoms usually occurs in patients taking insulin
what are common reasons for hypoglycaemia
food
inactivity
insulin
what are symptoms of hypoglycaemia
sweating
shaking
confusion
headache
what is the treatment for hypoglycaemia
any of:
- 200ml fruit juice
- half lucozade
- glucagon
- IV glucose
why is hypoglycaemia dangerous
can cause coma, hemiparesis, seizures (if hy[oglycaemia is prolonged neurological deficits may become permanent
what levels do blood glucose have to be to drive
5 to drive
what is the cause of diabetic ketoacidosis
too little insulin leading to fat breakdown associated with HIGH glucose levels (and type 1)
what are the symptoms of DKA
thirst high urine output abdominal pain tachy cardic / low BP acetone on breath
what are the ‘sick day rules’
NEVER stop taking insulin
frequent blood tests
check urine/blood ketones
maintain CHO intake
what is the treatment if a patient has hogh blood glucose levels and ketones are present
give extra dose of insulin and then recheck
in established DKA what investigations should be carried out initially
glucose
urinanalysis
blood ketones
venous blood gas
what is the treatment of established DKA in hospital
IV saline
IV glucose
IV potssium
what complications can DKA result in
hyper or hypokalaemia
hypoglycaemia
