VAD, Pain, HbAc1, Insulin

Question 1

What is Voluntary assisted dying rules?

Answer 1

• Voluntary assisted dying must be voluntary and initiated by the person themselves, it will usually be self-administered.
  
  • Only for those who are already dying from an incurable, advanced and progressive disease, illness or medical condition will be able to access voluntary assisted dying
  • Only for those who face inevitable, imminent death as a result of an incurable disease, illness or medical condition

Question 2

What are the two types of Pain rating scales?

Answer 2

• PQRST for those who can communicate

- Wong-baker faces for those who cant speak english or cannot communicate

Question 3

What is HbA1c?

Answer 3

Glycated Haemoglobin
→ refers to glucose 3 haemoglobin Joined together
→ reports the amount of Hb Alc as a proportion of total haemoglobin
→ RBC freely permeable to glucose molecules → Glucose t haemoglobin = Glycated haemoglobin
→ RBC 120 day lifespan → 3 month finger prick reflect BGL over 2-3 months

Question 4

What is the aim for HbA1c?

Answer 4

7%

HbAc1 does not equal a BGL

it is a percentage of the total haemoglobin bound by glucose

Question 5

What are the four types of insulin?

Answer 5

Rapid acting (bolus) 
Short acting 
Immediate acting (basal)
Long lasting (basal)

Question 6

Rapid acting insulin?

Answer 6

Bolus

• given 15 mins before a meal to cover the carbohydrates
• if lunch is missed do not give

Onset: 15 mins
Peak: 60-90 mins
Duration: 3-4 hours

Question 7

Short acting

Answer 7

• used less as difficult to time with meals
• more likely to cause hypoglycaemia as lasts longer
• given 30-45 mins before meals

Onset: 30mins-1hr
Peak: 2-3 hours
Duration: 4-6 hours

Question 8

Immediate acting and long lasting

Answer 8

Basal
- given once or twice a day to maintain BGL

Immediate
Onset: 2 hrs
Peak: 6-8 hrs
Duration: 12-16 hrs

Long lasting
Onset: 1-2 hrs
Peak: no pronounced peak
Duration: 24 + hours

Question 9

Storage of insulin

Answer 9

• Insulin is a protein
• Freezing or heating will alter molecule
  i. its effectiveness
• unopened can store in fridge
• open stove at room temp

Question 10

Administering insulin with a insulin pen

Answer 10

• Do not share between pts
• Prime: Put needle in pen & dial up 2 units 3 Squirt out
• ask pt where last injected & choose diff site (No alco wipes)
• Dial up prescribed dose & Insert into abdomen 90° (don’t pinch skin)
• Push on plunger, number go back to zero
• Wait 10 seconds before withdrawing tallow time med to be delivered)
• Ask pt to remove needle & place in hard container → Sharpe bin

Question 11

What is diabetes related liphypertrophy and what are the risk factors?

Answer 11

= characterised by thickened hard elastic adipose tissue of dense and fibrous texture
→ repeated injections into the same site cause natural immune response = Lipohypertrophy
→ caused by an anabolic effect on adipocytes (fat cells)

Risk factors: increased BMI. needle reuse, poor rotation of sites, frequency of injections, high HBAIC

Question 12

What is diabetes related peripheral neuropathy and what are the risk factors?

Answer 12

= Presence of clinical or subclinical evidence of peripheral nerve damage which cannot be attributed to other disease process
→ neuropathy can affect sensory nerves = pain, tingling, pins, numbness
→ motor nerves can be affected resulting in weakness, diminished reflexes
→ screening for neuropathy should be commenced when T2DM diagnosed and 5 years after diagnosis of T1 DM