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93 Cards in this Set
- Front
- Back
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HbA1c Target |
<6.5% |
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FBG Target |
4.4 - 6.1 mmol/L |
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RBG Target |
4.4 - 8.0 mmol/L |
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BP Target |
<= 130 / 80 mmHg (renal 125/75) |
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LDL-C Target TG HDL-C |
<= 2.6 mmol/L <=1.7 mmol/L >= 1.1 mmol/L |
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Blood sugar risk: < 7.8 mmol/L (<6.5%) 7.8 - 10.2 mmol/L (6.5 - 8%) 10.2 - 16.5 mmol/L (8 - 12%) |
IDEAL: < 7.8 mmol/L (<6.5%) CAUTION: 7.8 - 10.2 mmol/L (6.5 - 8%) TAKE ACTION!: 10.2 - 16.5 mmol/L (8 - 12%) - erectile dysfunction - blindness - heart disease - diabetic foot (can lead to amputation) - stroke - kidney disease |
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OGTT |
Oral Glucose Tolerance Test - not to eat, or drink certain fluids, for up to 8 to 12 hours before the test. - blood taken before the test (FBG). - take a very sweet tasting, glucose drink. - blood samples at regular intervals of 30 or 60 minutes or a single test after 2 hours. The test could take up to 3 hours. |
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Diagnostic FBG and RBG value? |
FBG : >=7.0 mmol/L RBG : >= 11.1 mmol/L |
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Tests to be carried out during each follow-up? |
1) weight 2) BP 3) BG |
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When oral agent monotherapy is initiated? |
1) glycaemic targets are not achieved despite lifestyle modifications within 3 months 2) marked hyperglycaemia in newly diagnosed |
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When combination OAD therapy is used? |
1) newly diagnosed with HbA1c 8-10, FBG > 10-13 2) not reaching targets after 3-6 months on mono |
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When combination of OAD and insulin is used? |
1) newly diagnosed with HbA1c >10, FBG >13 2) not reaching targets after 3-6 months on optimal doses of oral
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Types of insulin regimes |
1) OAD agents + pre-bed basal or pre-dinner premixed 2) Metformin + premixed more than OD 3) Metformin + basal + bolus |
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Diabetes Education would include .. |
1) diet 2) exercise 3) alcohol 4) smoking 5) medication 6) complications (acute and chronic) 7) self care /SMBG/ foot care 8) problem solving skills 9) pshycosocial adaptation to diabetes |
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mixtard dosing |
0.2u / kg / dose |
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optimal insulin dose |
0.5 - 0.7u / kg / dose 0.8 - 1.0u / kg / dose |
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actrapid |
0.1u / kg / dose |
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What is DM? |
amount of glucose in the blood is too high because the body cant use it properly. occurs when pancreas: 1) stops producing insulin 2) produces inadequate insulin; 3) cell resistant towards insulin
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What is insulin? |
like a 'lock' that allows glucose to enter and be used for energy/stored. |
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What are the risk factors of DM? |
1) family 2) sedentary lifestyle 3) high carbs/ sugar containing diet 4) obesity 5) certain illness and medications |
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What are the signs of DM? |
1) polyuria 2) polydipsia (thirsty) 3) fatigue 4) dry skin 5) weakness 6) loss of weight 7) blurring of vision 8) polyphagia (hunger) |
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Diabetic pills need to be taken all the time unless you are ... |
vomitting |
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Can a pt skip insulin injection if s/he plans not to eat? |
No. |
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For sick day management, it is recommended to check blood glucose more often which is before and 2 hours after each meal. if not able to eat regular meals, check every ... |
2-4 hours. |
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When sick, pt needs to drink plenty of plain water at least every hour or .. |
take small sips every 10-15 mins. |
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Insulin pen and needle consist of ... |
pen : cap, catridge holder and mechanical part needle: protective tab, outer cap and inner cap |
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How to prepare the insulin pen? |
1) pull the cap, unscrew catridge holder 2) return the piston rod by pressing it 3) remove insulin from packaging and inspect (type, expiration and appearance) 4) roll it gently to warm it (for cloudy insulin, invert cartdridge until uniformly cloudy) 5) insert into catridge and screw |
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Explain how priming is done? |
1) screw needle to pen and remove both cap 2) shake the pen up and down to mix it (for cloudy insulin only) 3) dial 2 units. hold pen with needle facing upwards and tap it gently to raise air bubbles (in KKM guideline, for novopen4, 4 units with new pen, 1 unit for used) 4) press the dose button fully. a drop of insulin should appear at the tip, if not, repeat. |
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What is the max dose for novopen and insuman? |
60 units and 80 respectively. |
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Needle should be placed ... degree from the surface |
90 |
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Needle need to be left under the skin for about ..... before pulling out |
6 secs (10 secs in KKM) |
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Which needle cap need to kept? |
Outer. |
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When the insulin catridge need to replaced? |
when the rubber plunger below the white line on the catridge holder. |
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Human Regular Fast acting: -Actrapid - Humulin R |
onset : 30-60 mins Peak : 2-4 hours duration: 6-10 hours timing: 30-60 mins before meals |
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Rapid Analogue: - Aspart (novorapid) - Lispro (humalog) |
onset : 5-15 mins Peak : 1-2 hours duration: 4-6 hours timing: 5-15 mins before meals (stat or shortly after meals) |
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Intermediate acting, human NPH insulin: - insulatard - humulin N |
onset : 1-2 hours Peak : 4-8 hours duration: 10-16 hours timing: pre breakfast / pre bed (normally one hour before bed) |
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long acting / basal analogue - glargine - detemir |
onset : 1-2 hours Peak : flat duration: ~24 hours timing: same time everyday of anytime of the day
for detemir, if pt on bd dosing, evening dose can be administered either with evening meal of at bedtime or 12 hours after morning dose. |
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premixed - mixtard 30/70 - humulin 30/70 - humalog mix 25/75 |
biphasic onset and peak duration: 10-16 hours timing: 30-60 mins before
if humalog, 5-15 mins before (stat) |
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Risk to having stroke is increased with |
uncontrolled ht, hyperlipidaemia and non adherence. |
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Nephropathy can lead to ... |
failure of renal function, may require life-long dialysis |
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Neuropathy/nerve damage can cause numbness, burning and tingling sensation, loss of sensory which can lead to ... |
amputation |
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Retinopathy can increase risk for |
cataracts, glaucoma and blindness |
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Complication towards dermopathy can cause diabetic pt to be more susceptible to skin infections, skin disorders and ... |
slow healing of wounds. |
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When diabetic pt is sick, s/he should try eating ... amount of carbs. |
same. |
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What happens when pt requires >60/80 units (in the case of insuman)? |
dose must be divided into 2 injections. |
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When inserting needle into the skin, pt needs to make sure that the dose scale ... |
can be seen by the pt. |
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To inject, press the push button as far as it will go or ... |
until hear or feel a click. |
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What happens if the insulin left in the cartridge LESS than the amount needed? |
1) inject the insulin left in the cartridge and note down the dose. then, replace with new insulin cartridge and select and inject the remaining dose needed
2) inject full dose with new insulin cartridge |
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Name some of the problems faced by pt regarding insulin injection. |
1) painful of uncomfortable injection 2) bleeding at injection site 3) insulin dripping from pen after injection 4) insulin leaking from injection site 5) clogging of needle 6) fat distribution problem: insulin exerts hypertrophic (enlargement) effect of adipose tissue. |
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Hypoglycaemia is when blood glucose level is below |
4 mmol/L (or 3.9 in KKM) |
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What are the causes of hypo? |
1) skipped meals 2) ill timing of administation 3) over exercise 4) excessive medication dose 5) sudden change in diet 6) alcohol consumption 7) wrong type of insulin |
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Sx of hypo includes: |
1) lethargy 2) dizziness 3) shivering 4) palpitation 5) sweating 6) hunger |
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When hypo occurs, pt is advised to ... |
take sugary drink: 2 teaspoons of sugar in 1/2 glass of water; orange juice or other fruit juice
or take sweets |
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Needles can be used for a max of ... times of injection. |
4 |
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Multiple use of needle can cause ... |
1) painful injection 2) unhygienic 3) hypertrophy / lipoathrophy 4) infection |
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Needles need to be disposed into a ... before being discarded. |
container |
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When injecting insulin at the abdomen, it needs to be done at any place ... fingers away from the ... |
2 ... navel (or 3 in KKM guideline) |
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When injecting insulin at the arm, it needs to be done in between ... fingers from the ... and ... |
4 ... shoulders ... elbow |
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When injecting insulin at the thigh, it needs to be done in between ... fingers from the ... and ... |
5 .. knee.. groin |
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Pts are advised not to self administer insulin if they are injecting it at the .... and ... |
arm hip/buttock |
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Site of injection needs to be rotated in between ... fingers from previous site. |
2 |
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Insulin is injected into ... tissue not .... |
fatty ... muscle |
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Unopened insulin need to be kept inside the .... |
fridge. (not at the door side of fridge) |
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If insulin stored at room temp, it sb discarded after ... days |
28 |
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Extreme temperature (hot, cold and direct sunlight) can cause insulin to ... |
1) lose potency 2) clump 3) frost 4) precipitate |
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The insulin pen needs to be stored inside the fridge. Yah or Nah? |
Nah. |
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In order to avoid changes in insulin concentration (expansion) / prevent air bubbles from entering cartridge (shrinkage), insulin pen ...... |
can't be kept with needle attached to it. |
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What factors need to be considered to ensure accuracy of SMBG? |
1) test strips sb used within expiry date and kept in original container 2) code on monitor should match with code on glucose test strip vial 3) first drop of blood from lateral site of finger is wiped off, then hanging drop is tested 4) insert strip at appropriate time and apply blood correctly over test strip 5) record each reading in diary and show to doc on the next appointment 6) clean monitor weekly or as needed. |
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Name all the types of OAD and give examples of each. |
1) Biguanides (metformin) 2) Suplhonylurea (gliclazide, glibenclamide) 3) Alpha-glucosidase inhibitor (acarbose) 4) Dipeptyl-peptidase inhibitor (DPP-4 inhibitor) (sitagliptin, vildagliptin, saxagliptin) 5) Meglitinides (repaglinide)
also combination: glucovance, janumet, galvusmet |
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Both biguanides and DPP-4 inhibitor decrease hepatic glucose production but one acts as insulin sensitizer while another stimulates insulin secretion. Which is which? |
insulin sensitizer - biguanides stimulate insulin secretion - DPP-4 inhibitor |
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Which OAD stimulate pancreas to release insulin? |
sulphonylurea and meglitinides |
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How does alpha-glucosidase inhibitor work? |
slows the absorption of carbs after eating |
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Explain the administration of each OAD. |
Biguanides - pc; with/immediately after evening meal (XR) Sulphonylurea - 30 mins before; just before breakfast (MR) Alpha-glucosidase inhibitor - to be chewed with first bite of main meal or swallow whole with a glass of water just before meal DPP-4 inhibitor - ac/pc Meglitinides - immediately before (short acting) |
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Which OAD can cause N&V, stomach discomfort, abdominal pain? |
DPP-4 inhibitor and meglitinides |
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Main s/e of sulphonylurea is ... |
hypo and weight gain. |
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Bloating, abdominal discomfort, diarrhea, stomach upset and gas are s/e of ... |
acarbose |
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Metformin if taken before food can cause ... |
nausea, diarrhea, GI discomfort, flatulence, gas, stomach upset and metallic taste. |
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Which insulin controls BG levels between meals? |
rapid and short acting |
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Which insulin controls BG levels during fasting? |
intermediate acting |
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Which insulin controls BG levels during both fasting and post meals? |
pre-mixed |
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...... insulin provides basal insulin requirement to control BG |
long acting |
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Which types of insulin are more prone to cause hypo and weight gain? |
short, intermediate and pre-mixed. |
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Insuman rapid is administed ... |
15 - 20 mins before meals |
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Insuman combo 30 is administed ... |
30 - 45 mins before meals |
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Insuman basal is administed ... |
45 - 69 mins before meals or pre-bed |
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The blue insuman pen is for which type of insulin? |
rapid |
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Results from autoimmune destruction of the beta cells in the pancreas.
This statement refers to .. |
Type 1 DM |
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Which insulins are cloudy? |
intermediate and premixed. |
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Initially, insulin dose will be adjusted at least .... to achieve blood glucose target. |
weekly |
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Why would we advise pt not to change injection part of body too frequent? |
due to diff absorption of insulin at diff parts of body |
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If hypo, pt is advised to .... insulin injection. |
omit |
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Diabetes can cause nerve damage and poor circulation in feet. Explain the consequences of this and steps of precaution pt needs to take. |
nerve damage means pt has poor pain sensation and is unaware of any injury to the feet. poor circulation means the injury or ulcer may be slow to heal. therefore, pt need to be advised to check feet everyday esp between the toes, soles and top of feet and heels.
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Before injecting the insulin, the skin that has been cleaned need to be .... to make a fold. |
pinched |
