(PM3B) Diabetes Self-Care & Management

Question 1

What support are pharmacists expected to offer for diabetic patients?

Answer 1

(1) Diet & lifestyle advice

(2) Offer locally commissioned services, e.g. weight management programmes

(3) NMS and MUR

Question 2

What monitoring is required for diabetic patients?

Answer 2

(1) Signs + symptoms of hypo/ hyperglycaemia

(2) Signs + symptoms of chronic complications

(3) Blood glucose level - daily required for young people with type 1

Question 3

What are the aims of treatment for diabetic patients?

Answer 3

(1) Improve QoL
(2) Regulate blood glucose
(3) Reduce risk of co-morbidities (complications)
(4) Reduce mortality

Question 4

What is/ are the main treatment option(s) for Type 1 diabetes mellitus?

Answer 4

Insulin

Question 5

What is/ are the main treatment option(s) for Type 2 diabetes mellitus?

Answer 5

(1) Metformin/ suphonylurea - especially if overweight

(2) Insulin

(3) Diet

Question 6

What should diabetic patients know about their treatment?

Answer 6

(1) Types of insulin
(2) Pen/ syringes other equipment

Question 7

What should be done with old insulin?

Answer 7

Disposed of

To make sure it is not confused with new insulin

Question 8

Can a patient administer their own insulin in hospital?

Answer 8

Yes.

They must tell staff they wish to continue administering their own insulin

Question 9

What is biphasic insulin?

Answer 9

A combination/ mix of insulin
- Rapid/ short-acting
- Intermediate

Question 10

What types of insulin pens are there?

Answer 10

(1) Pre-loaded disposable pen
(2) Re-usable injection pen

Question 11

Can IV syringes be used for insulin self-administration?

Answer 11

No. They should be avoided

Question 12

How should a syringe be described on the box for it to be considered appropriate for insulin administration?

Answer 12

“Insulin syringe”

Question 13

How should insulin that is IN USE be stored?

Answer 13

Below 25ºC

But NOT in the fridge

Up to 4 weeks

(2-8ºC fridge if not yet in use)

Question 14

What does a lumpy injection site indicate?

Answer 14

Lipohypertrophy - can affect absorption

Question 15

Name potential insulin injection sites, list them from fastest to slowest absorption.

Answer 15

(1) Abdomen
(2) Arms
(3) Thigh
(4) Buttocks

Question 16

What is an insulin passport?

Answer 16

A record of the patient’s current insulin preparations

Also emergency information

Comes with a patient information leaflet

Question 17

What is the clinical diagnosis for hypoglycaemia?

Answer 17

<4mmol/L plasma glucose

Question 18

What are common symptoms of a hypoglycaemic episode?

Answer 18

(1) Shaky/ dizzy
(2) Sweaty
(3) Irritability
(4) Fatigue

Question 19

What is the first line treatment for hypoglycaemia?

Answer 19

Immediate treatment:
ø 10-20g of rapidly-acting carbohydrate (sugar)

Question 20

How can hyperglycaemia be managed?

Answer 20

(1) Increased dose of insulin
(2) Change diet to avoid sugary foods
(3) Increase exercise
(4) Monitor glucose levels regularly

Question 21

What does extreme hyperglycaemia cause?

Answer 21

Diabetic Ketoacidosis

Question 22

How are blood glucose levels affected by DKA? What is this referred to as?

Answer 22

(1) Usually increase

(2) Sick day rules

Question 23

What are patients on insulin also given?

Answer 23

(1) Insulin passport
(2) Urine strips to test for ketones

Question 24

When sick, how often should a Type 1 diabetic patient check their blood glucose? What else is monitored?

Answer 24

Every 4 hours

Also urinary ketones

Question 25

What drugs can cause kidney damage to a diabetic patient when dehydrated?

Answer 25

• ACE inhibitors
• ARBs
• NSAIDs

Question 26

What is the increased risk of stroke for a diabetic patient?

Answer 26

2-4x as likely

Question 27

What would you advise a diabetic patient intending to fast, including for Ramadan?

Answer 27

AVOID fasting

Break the fast if blood glucose <3.5mmol/L

Question 28

What is amenorrhoea?

Answer 28

Absence of monthly period

Question 29

What would be your recommendation for a diabetic patient presenting with cystitis?

Answer 29

Refer to GP

Increased risk of nephritis

Question 30

What should be recommended for a diabetic patient presenting with an insect bite?

Answer 30

Recommend insect repellant

Refer if not improved in 1-2 days

AVOID hydrocortisone cream

Question 31

What are the requirements for a diabetic patient, regarding their driving licence?

Answer 31

(1) Inform DVLA of their condition

(2) Avoid hypoglycaemia - check blood glucose before driving

(3) Carry a supply of sugar in the car

(4) If experiencing hypoglycaemia/ symptoms STOP and consume sugar. WAIT 45 mins before continuing

Question 32

What effect can hot climates have on insulin?

Answer 32

May require more insulin

Question 33

What does a diabetic patient require before using air travel?

Answer 33

A letter from the GP

Explaining need for carrying syringes + needles + insulin

Question 34

Should diabetic patients be advised to get a flu jab?

Answer 34

Yes.

Flu vaccine is important for diabetic patients.

Pneumococcal pneumonia vaccination is also recommended