(PM3B) Diabetes Self-Care & Management Flashcards
What support are pharmacists expected to offer for diabetic patients?
(1) Diet & lifestyle advice
(2) Offer locally commissioned services, e.g. weight management programmes
(3) NMS and MUR
What monitoring is required for diabetic patients?
(1) Signs + symptoms of hypo/ hyperglycaemia
(2) Signs + symptoms of chronic complications
(3) Blood glucose level - daily required for young people with type 1
What are the aims of treatment for diabetic patients?
(1) Improve QoL
(2) Regulate blood glucose
(3) Reduce risk of co-morbidities (complications)
(4) Reduce mortality
What is/ are the main treatment option(s) for Type 1 diabetes mellitus?
Insulin
What is/ are the main treatment option(s) for Type 2 diabetes mellitus?
(1) Metformin/ suphonylurea - especially if overweight
(2) Insulin
(3) Diet
What should diabetic patients know about their treatment?
(1) Types of insulin
(2) Pen/ syringes other equipment
What should be done with old insulin?
Disposed of
To make sure it is not confused with new insulin
Can a patient administer their own insulin in hospital?
Yes.
They must tell staff they wish to continue administering their own insulin
What is biphasic insulin?
A combination/ mix of insulin
- Rapid/ short-acting
- Intermediate
What types of insulin are there?
(1) Pre-loaded disposable pen
(2) Re-usable injection pen
Can IV syringes be used for insulin self-administration?
No. They should be avoided
How should a syringe be described on the box for it to be considered appropriate for insulin administration?
“Insulin syringe”
How should insulin that is IN USE be stored?
Below 25ºC
But NOT in the fridge
Up to 4 weeks
(2-8ºC fridge if not yet in use)
What does a lumpy injection site indicate?
Lipohypertrophy - can affect absorption
What can lipohypertrophy affect?
Absorption of the the drug
e.g. insulin
Name potential insulin injection sites, list them from fastest to slowest absorption.
(1) Abdomen
(2) Arms
(3) Thigh
(4) Buttocks
How can lipohypertrophy be avoided?
Rotate injections sites
Important to use both left and right
What is an insulin passport?
A record of the patient’s current insulin preparations
Also emergency information
Comes with a patient information leaflet
What is also given with an insulin passport to the patient?
Patient information leaflet
Information on how to safely administer insulin
What is the clinical diagnosis for hypoglycaemia?
<4mmol/L plasma glucose
What are common symptoms of a hypoglycaemic episode?
(1) Shaky/ dizzy
(2) Sweaty
(3) Irritability
(4) Fatigue
What is the first line treatment for hypoglycaemia?
Immediate treatment:
ø 10-20g of rapidly-acting carbohydrate (sugar)
How can hyperglycaemia be managed?
(1) Increased dose of insulin
(2) Change diet to avoid sugary foods
(3) Increase exercise
(4) Monitor glucose levels regularly
What does extreme hyperglycaemia cause?
Diabetic Ketoacidosis
How are blood glucose levels affected by illness? What is this referred to as?
(1) Usually increase
(2) Sick day rules
What are patients on insulin also given?
(1) Insulin passport
(2) Urine strips to test for ketones
When sick, how often should a Type 1 diabetic patient check their blood glucose? What else is monitored?
Every 4 hours
Also urinary ketones
What drugs can cause kidney damage to a diabetic patient when dehydrated?
- ACE inhibitors
- ARBs
- NSAIDs
What is blood glucose level is considered hypoglycaemia?
> 11mmol/L
What is the increased risk of stroke for a diabetes patient?
2-4x as likely
What would you advise a diabetic patient intending to fast, including for Ramadan?
AVOID fasting
Break the fast if blood glucose <3.5mmol/L
What is amenorrhoea?
Absence of monthly period
What is cystitis?
Inflammation of the bladder
Normally due to infection
What would be your recommendation for a diabetic patient presenting with cystitis?
Refer to GP
Increased risk of nephritis
What should be recommended for a diabetic patient presenting with an insect bite?
Recommend insect repellant
Refer if not improved in 1-2 days
AVOID hydrocortisone cream
What are the requirements for a diabetic patient, regarding their driving licence?
(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
What effect can hot climates have on insulin?
May require more insulin
What does a diabetic patient require before using air travel?
A letter from the GP
Explaining need for carrying syringes + needles + insulin
Should diabetic patients be advised to get a flu jab?
Yes.
Flu vaccine is important for diabetic patients.
Pneumococcal pneumonia vaccination is also recommended
