I can't find my notes from my Pharmacy BTEC about diabetes, i think i either threw them away in disgust, scribbled all over them or left them a work so i could have a good laugh next time i'm down...
Oh, i found my assignment...see how realistic this probably isn't...
Diabetes
Case Study 1
Keith Thomas is an 18 year old who has been recently diagnosed with diabetes. He?s about to start university and after discussions with the diabetic nurse he has decided to go onto a multiple injection regimen, as opposed to twice daily injections.
How does the multiple injection regimen work?
Keith will take several injections a day of short and intermediate acting insulins.
Class Examples of products Duration of action
short
Hypurin
Pork Actrapid
Actrapid
Velosulin
Humulin S
Novorapid (Insulin Aspart)
Humalog (Insulin Lispro)
? - 8 hours
Intermediate Insulatard (Isophane Insulin)
Novomix
(Biphasic Insulin Aspart)
Humalog mix 25
Mixtard
(biphase isophane insulin)
? - 24 hours
Long Levemir (Insulin Determir)
Lantus (Insulin Glargine)
Protamine Zinc Insulin
Insulin Zinc Suspension
2 - 36 hours
List of Insulin regimens:
? Short acting insulin and intermediate acting insulin before meals twice a day.
? Short acting insulin and intermediate acting insulin before breakfast then short acting insulin before and evening meal then intermediate acting before bed.
? Short acting insulin three times a day before each meal and intermediate before bed.
? Intermediate or short before breakfast or bed.
What are the advantages and disadvantages of the multiple injection regime?
Advantages
Insulin levels are fairly constant all day and there are no peaks or troughs.
Easy to remember to take
Disadvantages
Have to find more injection sites
More injections each day.
More expensive as more doses of insulin are needed.
What are the causes of hypoglycemia in a patient with Insulin dependant diabetes mellitus?
A tight control of blood glucose levels makes it easier to suffer from hypoglycemia, low blood sugar and the more hypoglycemic attacks a patient has the less obvious the warning signs. Using human insulin can also reduce the clearness of warning signs.
It can be brought on by using too much insulin and eating the wrong food at the wrong time.
What are the warning signs?
? Tremour (shaking of the limbs, especially the hands)
? Palpitations
? Dizziness and lightheadedness
? Loss of consciousness and coma.
(hang on....coma? warning sign? i'd say that was a little late for a warning wouldn't you readers?)
How would a patient manage an attack?
Eat or drink something sweet, like chocolate or glucose sweets, also lucosade and coca cola. They can also take oral glucose gel. If this is not enough or is not given at the onset of symptoms, they can administer a glucagon injection which encourages glycogen production in the liver. In hospital cases they can be given intravenous glucose.
What are the possible long term complications of diabetes?
? Glaucoma, which is more common in people with diabetes.
? Kidney disease
? Bad circulation leading to circulation disorders including peripheral hypotension and ulcers.
? Coeliac disease
? Thyroid disorders
If Keith were to run out of insulin supplies, what options would be open to him?
Keith should be able to get an emergency supply of insulin from pharmacies and hospitals in his local area. If he attended A+E out of hours he could get some more.
Case Study 2
Mr Davies
Mr Davies is obese (BMI= 33) 45 year old whho smokes around 20 cigarettes a day and drinks over average quantities of alcohol. Hs is the manager of a small electronics company. He has been on bendrofluazide 5mg in the morning for the past year or so, but has recently vivited his GP complaining of nocturia and been thirsty for much of the time. His GP has carried out tests and had confirmed that he has type 2 diabetes. He has been prescribed metformin and been sent to the diabetic nurse to find out about glucose testing.
His repeat prescripton is:
Metformin 500mg TDS
Bendrofluazide 5mg OM
Glucotrend plus test strips
His GP has told him that he needs to improve his lifestyle practice and control his blood sugar levels effectively.
What are Mr Davies? risk factors for developing diabetic complications?
? Atheroma and thrombosis. Which is not helped by his drinking, smoking or lack of exercise.
? Kidney damage leading to kidney failure. Which is also agrrevated by his drinking.
? damage to the small arteries of the retina at the back of the eye).
? Nerve damage.
? Poor circulation, leading to having problems such as ulcers and badly healed wounds, especially at the extremities.
? Impotence
(Note to self, never tell this to a customer or patient....grrrrrr, now you know why i don't work in community and arn't let near the patients...lol)
What changes does he need to make to his lifestyle?
? Stop smoking, which we can help you with by recommending services and products to help you give up.
? Lose weight, again there are people who can help you with that. Try to eat 5 fruit and vegetables a day and cut down on fatty food. Try to take more exercise, it can be hard if you sit down a lot a work, but start with small things like going for walks, or you could join the gym.
? Try to reduce your alcohol intake.
? Remember to attend any appointments you have with your GP and the diabetic nurse.
? Get a flu jab in winter. Flu can be more dangerous if you have diabetes.
? Try to reduce you blood pressure. Think about ways you can relax at home and at work.
Three months later and the nurse has recommended that Mr Davies take another anti-diabetic drug.
What group of drug might be appropriate to add to his current medication?
A sulphonylurea such as Tolbutamide, Chlorpropamide, Glibenclamide or Glipizide. These drugs should compliment the use of Metformin and are often given together in patients who can?t control their diabetes with one drug alone.
Under what circumstances would Mr Davies be put on insulin therapy?
If Mr Davies cannot control his blood sugar levels with both the metformin and the suphonylurea then he may be given insulin instead of his regular drug or in addition to them.
What first line anti-hypertensive would you recommend to Mr Davies?
? Doxazosin or another Calcium Channel Blocker
? Angiotensin 2 recptor antagonists (irbesartan, candesartan, telmsartan) These are also used to treat diabetic nephropathy (kidney damage) so they might be doubly useful Mr Davies? case.
There, and i think i passed, i mighyt even have gotten a distinction for that...I sort of remeber writing down somewhere that type 1 happens to children and type 2 happens to old people (sorry everyone, i'm insulting myself as much as i am you, if not more coz look how stuuupid i was...).
I've also written down some of the symptoms of persistant hyperglycemia (oh, little did i know how much experience i'd get of that...and how soon) as "fainting" and "lack of feeling".🙄 I have to admit, sometimes diabetes does leave me a bit unfeeling, usually towards the people sitting around filling thier faces with cake and complaining that they need to go on a diet!
Rachel
(Please, don't take offense, i'm older, wiser and diabetic now. And i've learn to avoid telling people about impotence unless it's absolutely nessesary..)
I wouldn't have gotten so ill if I'd known about the condition and the classic symptoms I had xx
