Modules Flashcards
who should be referred to the specialist diabetes team on admission to hospital (8)?
DKA diabetes and pregnancy new type 1 diagnosis HHS recurrent or severe hypoglycaemia Poor glycaemic control Require insulin initiation complications such as autonomic neuropathy and/or foot ulcers
what unrelated illnesses/treatments may cause a required alteration to diabetes treatment?
acute coronary syndrome parenteral feeding vomiting sepsis treatment with corticosteroid IV insulin for >48 hrs Continuous subcutaneous insulin infusion pumps
who is at increased risk of foot problems while in hospital?
patients with neuropathy
previous ulcer or amputation
bed bound or fragile skin
a what points should blood glucose be measured in a diabetic patient during a hospital stay?
- on admission
2. before every SC insulin injection, or hourly while on IV insulin
how often is blood glucose measured if unwell patient?
4 times per day
when is blood glucose checked if hypoglycaemic?
15 mins after administering treatment (to check if its working)
how often do you check blood glucose if on SURs vs metformin?
SURs = twice daily metformin = once daily (before meals)
how often do you check blood glucose in diet controlled diabetic?
once daily (before meals)
definition of hypoglycaemia in people on treatment for diabetes?
<4mmol/L
which hormones are involved in the autonomic nervous system response to blood glucose?
cortisol
glucagon
adrenaline
growth hormone
how does the liver respond to hypoglycaemia and how can this be impaired>
releases glucose from glycogen stores can be impaired in people with - malnourished - extensive liver disease - recurrent hypoglycaemia - consumed alcohol to excess
what are the autonomic symptoms of hypoglycaemia?
trembling anxiety numbness/tingling palpitations irritability hunger pale and sweaty vulnerable and afraid
what causes neuroglycopaenic symptoms in a hypoglycaemic episode?
when blood glucose falls <2mmol/L, impaired supply to the brain
what neuroglycopaenic symptoms can occur with hypoglycaemia?
problems with weakness, coordination and concentration slurred speech problems with vision loss of consciousness seizures
how can hypoglycaemia be quickly managed in patients who can swallow?
give quick acting carbohydrates
- 150-200ml fruit juice (avoid in renal failure)
- 60ml glucojuice
- 4-5 glucotabs
how can hypoglycaemia be quickly managed in patients who are drowsy/confused but can swallow?
glucose gel
1.5-2 tubes squeezed between teeth and gums
how can hypoglycaemia be managed in an unconscious patient?
ABCDE
call a doctor
stop any IV insulin
IV glucose or IV/intra-muscular glucagon
how is IV glucose administered?
150ml 10% glucose over 10-15 mins
75ml 20% glucose over 10-15 mins
what may reduce the effectiveness of glucagon injection?
liver disease
malnourishment
repeated hypoglycaemia
OHA induced hypoglycaemia
how is glucagon administered?
don’t use in OHA induced hypo
1mg in adults (>25kg)500 micrograms in kids <8 (<25kg)
store in the fridge
given via subcutaneous, intramuscular or IV injection
how do you know if further glucose treatment is needed in hypoglycaemia?
if blood glucose is still >4 after 15 mins
where are the common sites for subcutaneous insulin injection?
abdomen
upper outer thigh
upper outer leg
buttocks
what are the 4 key principles of insulin injection?
rotate site for each injection (i.e if injecting 4 times a day - inject at different site each time)
use the same general location for injection at the same time of day
change the pen needle or syringe each time
inject the same insulin in the same area every day (e.g long acting always in the abdomen) while ensuring that you rotate the specific site of injection within the area each time
what is the most common complication that can occur at insulin injection sites and what are the implications of this?
lipohypertrophy at site of repeated injection
causes reduced absorption of insulin at that site so should be avoided for insulin injection
at what concentration is insulin usually given in hospitals in the UK?
100 units per ml
name 2 therapies which can cause hyperglycaemia?
corticosteroids
parenteral nutrition
give 2 common errors which result in the incorrect delivery of insulin
use of wrong syringes which are marked in ml rather than insulin units
abbreviation of “units” to “U” which could be misread as a 0 - i.e “10 U” could be misread as “100”
rapid acting analogue vs short acting?
rapid = immediate effect, peaks at 2 hrs short = takes 30 mins to take effect, peaks at 4 hrs
give 3 examples of rapid acting insulin analogues
Humalog
novorapid
aprida
give 3 examples of short acting insulin?
actrapid
humalin S
insuman rapid
intermediate vs long acting insulin?
intermediate = lasts 16 hrs but higher peak basal insulin level than long acting
long acting = lasts 24 hrs but lower peak basal insulin level
what are the two types of fixed insulin mixtures available?
rapid acting-intermediate mixture (humulog mix/novorapid mix)
short acting-intermediate mixture (humalin M3
what problems could arise if Humalog is given instead of Humalog mix?
high risk of hypoglycaemia as Humalog os 100% rapid acting insulin
kidney failure can lead to hypo or hyperglycaemia?
hypoglycaemia
impaired kidney function = impaired excretion of insulin so its effects last longer
how do you review blood glucose patterns in patients on twice daily insulin regimens?
measure blood glucose pattern over past 48 hrs
what advice would you give if 48hr blood glucose pattern is over target in someone on twice daily insulin regimen?
increase insulin dose by 10% either before breakfast or dinner
what advice would you give if 48hr blood glucose pattern is under 6 in someone on twice daily insulin regimen?
reduce insulin dose by 10% either before breakfast or before dinner
does insulin have a long or a short half life, what are the implications of this>
short (5 mins)
means risk of insulin omission if IV line is disconnected
- can lead to DKA
rule for patients on multiple daily injections if on IV insulin?
continue long acting basal insulin
prevents DKA by aiding transfer from IV to SC
how are insulin and fluids prescribed together?
through the same cannula
is IV insulin always prescribed with fluids?
yes
apart from in critical setting and advised by senior
what measures insure insulin and fluid remain infusing safely?
anti-syphon valve - prevents free flow in insulin from the syringe driver
anti-reflux valve - prevents backflow of insulin
is mealtime insulin needed during IV insulin treatment?
usually not - if fasting
can be used alongside if post DKA or antenatal
how often should you check capillary glucose after stopping IV insulin?
4 times in 24 hrs following end of IV treatment
when do you transfer back to oral medication after IV insulin?
when patient is clinically stable and tolerating food and fluids
start medications at a meal time and then stop IV after 1 hr
check for contraindications (renal function) and check blood glucose regularly
how often do you check blood glucose while on IV insulin?
what else do you check?
hourly
also check Us&Es daily
