SpR / StR teaching in GIM 18 th November 2013 Nick Lewis-Barned.

Slides:



Advertisements
Similar presentations
In-Patient Management of Hyperglycemia Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center.
Advertisements

Diabetes – sick day rules. Scenario Katie is a 15 year old girl with diabetes 3 day history of cough productive of green sputum, shortness of breath and.
Treatment in Cardiac disease The PNs Roll Dr. Sergio Diez Alvarez Staff Specialist Physician Armidale Hospital.
Canadian Diabetes Association Clinical Practice Guidelines Pharmacologic Management of Type 2 Diabetes Chapter 13 William Harper, Maureen Clement, Ronald.
Chris Harrold SpR Diabetes & Endocrinology.  Diabetes is common  15% of all inpatients  50% of those are on insulin  20% of patients experienced an.
Insulin Diabetes Outreach (June 2011). 2 Insulin Learning outcomes >Understand the difference between insulin therapy in type 1 diabetes as compared to.
Paediatric Diabetes Nurses October 2013 Diabetes Update.
Nicola Trevelyan Consultant Paediatrician Nov 2007
Type 1 Diabetes Debbie McCausland Paediatric Diabetes Specialist Nurses.
Insulin Initiation for Type 2 diabetes in General Practice
Insulin Prescribing.
Case Studies on Insulin Initiation
Drugs used in Diabetes Dr Sally Hudson. BIGUANIDES reduce output of glucose from the liver and enhances uptake and use of glucose by muscle cells ExampleADVANTAGESDISADVANTAGESCOSTCaution.
Management of Inpatient Blood Glucose at Temple Housestaff Orientation 2014.
Hypoglycaemia Diabetes Outreach (June 2011). 2 Hypoglycaemia Learning outcomes >Can state what hypoglycaemia is >Be able to assess who is at risk of hypoglycaemia.
Module 3 Initial Recognition, Triaging, and Management of Hyperglycemia Diabetes Special Interest Group Georgia Hospital Association.
PAEDIATRIC DIABETES SCHOOL MANGEMENT Jan Reddick PDNS.
Inpatient Glycemic Management
Prevention of admission & Discharge Planning DR ANDREW SOLOMON DR CHANTAL KONG DEBBIE STANISSTREE T.
Insulin Conundrums Veronica Green *p < **p = Epidemiological extrapolation showing benefit of a 1% reduction in mean HbA 1c with a mean.
Hypoglycemia & Hyperglycemia Dave Joffe, BSPharm, CDE, FACA Part 4.
Dr Stanley Ngare.  Pharmacology of Types of insulin available  Various routes of delivery & factors that affect absorption  Patient and provider barriers.
Insulin Glargine (Lantus) Lantus is a long-acting insulin that should be injected below the skin once daily as directed by your doctor. Take Lantus the.
Insulin Initiation In Primary Care Dr Arla Ogilvie Endocrinologist Watford General Hospital West Herts Hospitals NHS Trust.
1 Diabetes In Hospital Prepared by [Lynne Gilks] [CNC Diabetes Education] [Tamworth Diabetes Centre] [Nov 2010]
1 Module 5 Pharmacologic Management of Hospital Hyperglycemia: Insulin Management Part 2 Diabetes Special Interest Group Georgia Hospital Association.
Speaker name and affiliation UKDBT01539 September 2013
Achieving Glycemic Control in the Hospital Setting
Laboratory Testing For Cardiovascular Risk
ADDITIONAL SLIDES FOR ASSIST WITH COMPREHENSION OF LAB CONTENT-MODULE FIVE-DM DENISE TURNER, MS-N.ED, RN, CCRN.
Insulin initiation in Type 2 Diabetes
What Key Personal Need To Know INSULIN ADMINISTRATION.
Diabetes, Surgery and GKI’s Maureen Wallymahmed Nurse Consultant - Diabetes.
Insulin Optimisation Workshop Theingi Aung & Claire Rowell.
Special Situations In The Management Of In-Patient Hyperglycemia
Stroke Hyperglycemia Insulin Network Effort (SHINE) Trial Treatment Protocol Cases.
Quality of Life Matters NOT TOO HIGH… NOT TOO LOW… A PLAN FOR OPTIMIZING DIABETES MANAGEMENT IN NURSING HOMES 5. Insulin: Part 1.
Management of Adult Diabetic Ketoacidosis Adapted from the WHO IMAI District Clinician Manual Vol. 1 Dr. Linda Hawker, June 2014.
Small concise points on Insulin
Insulins Roland Halil, BScPharm, ACPR, PharmD
Insulin Type (trade name)
Jill Little Diabetes Specialist Nurse
Drugs for Type 2 Diabetes – where next after metformin ?
Pharmacy Protocol for Insulin Dosing in the Hospitalized Patient
Mastery of Medicine in Diabetes Management Video Roundtable
Insulins Roland Halil, BScPharm, ACPR, PharmD
Alisa Foote SDSU School of Nursing 10/14/11.
Diabetes Medications in the Top 200
Insulins Roland Halil, BScPharm, ACPR, PharmD
Endocrine System KNH 411.
Insulins in primary care setting
Endocrine System KNH 411.
Jill Little Diabetes Specialist Nurse
Injectable Therapies in Diabetes
10 Top tips for insulin administration
Insulin Safety know your insulins! There are many! Humalog® Mix25 Humalog® Mix50 Humulin® I Humulin® M3 Humulin® S Humalog® U-100 Humalog® U-200.
T1DM: Insulin Initiation
Endocrine System KNH 411.
Treatment Pathway for Adults with Type 1 Diabetes
Injectable Options as Add-Ons to Basal Insulin: Targeting PPG in Type 2 Diabetes Patients.
Insulin Refresher slides Date of preparation: June 2017
Diabetes Specialist Nurses
Endocrine System KNH 411.
Endocrine System KNH 411.
Endocrine System KNH 411.
Scenario 2.
Diabetes Source: Medicine Issue Date: 12/2010
Inpatient Insulin Management on the Wards
CPPE Optimise: Insulins
MANDATORY INSULIN EDUCATION
Presentation transcript:

SpR / StR teaching in GIM 18 th November 2013 Nick Lewis-Barned

What you asked for 12 responses Some themes Answering practical questions Looking fro accessible resources

What you asked for Management of newly presenting diabetes – Distinguishing Type 1 and Type 2 diabetes – When safe not to admit (GP calls, high BGL) – Initial management of Type 1 / Type 2 When to worry about raised BGL in inpatients – Out of hours – Adjusting doses – Postnatal – Missed insulin dose – how to correct

What you asked for Concomitant illness – Starting treatment for the first time – Glucose targets – Short term illness / steroid therapy – Frail elderly, treatment safety and withdrawal Management of DKA / HHS – Transferring from iv to sc insulin – Maintenance of background insulin in DKA – Deciding doses in young adults / low body weight

What you asked for Deciding on insulin type (profiles) Type 2 diabetes stepped approach – Conventional agents – Newer agents Miscellaneous – What’s a good diet?Weight loss &Type 1 diabetes – How often is im glucagon ok? – Statin choices – Hypos and renal failure, glucose iv and pancreas transplant

Scenario 1 Phone calls from GPs to say they have patients with BMs , who are well and don’t have ketones on urine dip. Struggle to know how best to manage, so sometimes end up admitting to just be able to assess them Is that the right thing to do and best use of services? Which of these ‘well’ hyperglycaemic patients should be assessed in hospital

Scenario 1 What are the key safety questions? What are the first steps? When would you start what and what might your follow up be? How would you decide an insulin dose if you though this was necessary? What are the key things the person would need to know / be able to do?

Scenario 2 Well Type 2 within infected leg ulcers and BGL 25+. Seen late at night having missed 6pm insulin on iv insulin and 10% glucose with BGL getting worse. Gave her her 80+ unit premixed insulin Could her evening insulin hang around and make her dip in the morning?

Scenario 2 What types of insulin do you know? How would you go about answering the question? Wat would you have done and why?

Insulin profiles – types of insulin Circulating insulin levels Soluble (Actrapid / Humulin S) Isophane (Insulatard / Humulin I) Rapid acting analogue (Novorapid / Humalog) Ultra long acting insulin (Detemir / Glargine)

Common insulin regimes 2 injections: The soluble and isophane insulin can either be given separately or premixed ‘b.d. mix’ Food / snacks Injections: In this regime background insulin is provided by twice daily medium acting insulin ‘split basal’ Short actingMedium actingLong acting Night time ‘Basal bolus’ 4 Injections: In this regime daytime background insulin is provided by long acting insulin

Scenario 3 54 year old woman. Significantly overweight (BMI 33). Glucose 25 on admission with MI. No ketones. After 3 days her BGLs are in the range of 13 – 18. What’s the best way to get her started on treatment?

Scenario 3 What factors wold help to decide your treatment choice? What are your choices beyond metformin and gliclazide? When might you consider these and why? If she also has COPD how would you manage exacerbations / steroid treatment?

What’s left? Key questions around DKA / HHS and insulin infusions

What you asked for Concomitant illness – Starting treatment for the first time – Glucose targets – Short term illness / steroid therapy – Frail elderly, treatment safety and withdrawal Management of DKA / HHS – Transferring from iv to sc insulin – Maintenance of background insulin in DKA – Deciding doses in young adults / low body weight

What you asked for Deciding on insulin type (profiles) Type 2 diabetes stepped approach – Conventional agents – Newer agents Miscellaneous – What’s a good diet?Weight loss &Type 1 diabetes – How often is im glucagon ok? – Statin choices – Hypos and renal failure, glucose iv and pancreas transplant