Diabetes

• Normal blood glucose rate (without diabetes) 3.4 to 5.8 mmol/l
• Diagnostic: Symptoms and one of the following; random venous plasma glucose of 11.1 mmol/l or above. Fasting venous plasma glucose of 7 mmol/l or above. Plasma glucose of 11.1 mmol/l or above after a 75 g oral glucose load.
• Diagnostic with no symptoms: Same tests as with symptoms however will need to do the test twice.
• Urine dipstick or finger prick are not sufficient to be used to diagnose patients with diabetes
• HbA1c: shows levels of glucose bound haemoglobin. Used as a diagnostic measure for type 2 diabetes. Results of 48 mmol/l (6.5%) plus symptoms is considered to be diagnostic. If no symptoms repeat HbA1c after 2 weeks to confirm.
• When diagnosed with diabetes other investigations need to take place such as blood pressure, urine analysis, renal function, liver function and lipids.

  Renal and liver function to see what drugs can be used.
• Lipohypertrophy: lump under skin that is painful and caused by injecting insulin at the same spot without rotation.
• Hypoglycaemia: when glucose levels are below 4 mmol/l
• Mild symptoms of hypoglycaemia: Tremor, hunger & sweating (blocked by beta-blockers). blurred vision and headache.
• Moderate symptoms of hypoglycaemia: Behaviour change such as restlessness, agitation, drowsiness and confusion.
• Severe symptoms of hypoglycaemia: very aggressive, unconscious, seizure and coma
• Mild symptoms of hypoglycaemia treat with 15 to 20 grams of rapidly absorbed sugar such as 1.5 to 2 tubes of GlucoGel.
• Moderate symptoms treatment of hypoglycaemia: 1.5 to 2 tubes of GlucoGel.
• Severe symptoms of hypoglycaemia treat with IV glucose (150ml of 10% over 10 to 15 minutes)
• Causes of hypoglycaemia could be due to incorrect dosage of insulin at night, missed meals, excess alcohol, more exercise than usual or excess heat or stress.
• Rapid acting insulin (NovoRapid): injected 50 to 15 minutes before eating, when eating or immediately after eating. Last between 2 to 5 hours. Often take with longer acting insulin.
• Short acting insulin (Actrapid): Injected 15 to 30 minutes before a meal as slow onset and can work up to 8 hours. Used in combination with long acting insulin.
• Medium NPH (Insulatard) & long (Levemir) acting: Injected at night and work up to 24 hours. Used with short acting.
• Analogue mixtures (Novomix 30): mixture of long acting and short acting. Injected 5 to 15 minutes before eating, when eating or after eating. last 14 to 16 hours. Used twice daily.
• Patient regime: Lantus (long acting) OD ON and NovaRapid (short acting) at meal times. Good regime for busy patients or patients that travel a lot. Disadvantage is more injections
• Patient regime twice daily: Short acting plus intermediate acting pre mix (Novomix 30). Advantages is that it is simple and less injections. Disadvantage is that it is inflexible as has to be given fixed time and you cannot delay meals.
• Patient regime once daily: Long acting (lantus) once daily at night. Used in combination with oral hypoglycaemics. Only used for type 2 diabetics.
• IV insulin only used for emergences at hospital. For example during labour or during surgery or unstable glucose levels for any reason.
• When adjusting does of insulin it should be by 10% aliquots. Insulin should be stored in fridge however pens should be kept at room temperature. Insulin can stay outside fridge for 1 month.
• If patient is sick they should still take insulin and test blood more often (4x daily). Patient should also test for ketones using ketostix. Drink plenty of fluids and replace normal meals with carbohydrate containing drinks if needed.