Patients on statins should be monitored for diabetes as a link has been found ebtween development of diabetes in post-menopausal women and statin intake.
Culver, AL. et al (2012) Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative Arch Intern Med 2012
Taken from Holt, P. (2011) Managing hypoglycaemiaIndependent Nurse 17/10/11 18-29-30
(Guide only, type 2 diabetes can be asymptomatic for years)
| Symptoms | Type 1 Diabetes | Type 2 Diabetes |
| Onset | Fast (days/weeks) | Slow (months/years) |
| Thirst | √ often profound | √ |
| Polyuria/nocturia | √ | √ |
| Bedwetting in children | √ | - |
| Lethargy/tiredness | √ | √ |
| Mood changes/irritability | √ | √ |
| Weight loss | √++ | √+/- |
| Visual disturbances | √ | √ |
| Thrush infections (genital) | - | √ |
| Recurrent infections (boils/ulcers) | - | √ |
| Hunger | √ | √ |
| Tingling/pain/numbness in extremities | - | √ |
| Occasionally abdominal pain | √ | - |
| Confusion | If advanced | √ Especially in the elderly |
| Incontinence | - | √ Especially in the elderly |
| Glucosuria | √ | May be absent especially in the elderly or if there is a high renal threshold |
| Ketones in urine or blood | May be present (ketoacidosis) | Likely to be present |
Thanks to Practice Nurse 41 8
Patient is unable to self-treat. If conscious, and able to swallow safely, patient should be given one of the following:
Repeat as required and stay with patient until recovered.
If patient is unconscious, he should be put in recovery position, glucagon can be injected if trained to do so. Otherwise dial 999 for ambulance.
| HbA1c DCCT (%) | 6.0 | 6.5 | 7.0 | 7.5 | 8.0 | 8.5 | 9.0 | 9.5 |
| HbA1c IFCC (mmol/mol) | 42 | 48 | 53 | 59 | 64 | 69 | 75 | 80 |
| Age | >60 years | 1 point |
| Blood pressure | >140/90mmHg | 1 point |
| Clinical signs | Unilateral weaknessSpeech disturbance | 2 points1 point |
| Duration of symptoms | 0-59 mins60 mins or more | 1 point2 points |
| Diabetes | Diabetes | 1 point |
Score 4 or more indicates significant risk of CVA
Thanks to Practice Nurse 41 8 for this.
Type I diabetes occurs when there is a loss of insulin secretion ability due to automimmune destruction of the beta cells in pancreatic tissue. Patients generally present with the symptoms of hyperglycaemia including ketoacidosis.
Type I diabetes is the most common form in young people (affecting aout 0.5% of the population); bringing with it the potential for problems such as retinopathy, neuropathy, nephropathy and vascular disease.
Small amounts of insulin are produced by the pancreas throughout the day to ensure cells have access to glucose, and suppress the release of stored glucose from the liver. During fasting periods, glucagon is released to ensure glucose supplies for brain function.
Carbohydrates are digested in order to provide glucose, which results in the release of insulin titrated to the supply of glucose to use and store glucose in suitable quantities.
Insulin needs to be replaced in type I diabetes patients to ensure 24 hour cover. Boluses may also need to be prescribd to match carbohydrate intake at mealtimes. Often this can be suitably treated with a twice daily insulin if the patient’s daily routine is predictable, for patients whose lifestyle is more varied, titrated insulin may be required perhaps involving a pump or more frequent injections.
Carbohydrate awareness is important for those with type I diabetes because it is carbohydrates that affect blood glucose levels, and therefore patients need to be aware of the carbohydrate values of the foods they consume. This is particularly important for those titrating their insulin.
One of the ways insulin titration is done is through ‘dose adjustment for normal eating’ (DAFNE) which was designed for those with type I diabetes and can contribute to an improved quality of life and satisfaction for patients. Research shows that patients on DAFNE treatment are less likely to be admitted to hospital with ketoacidosis or hypoglycaemia, and also the treatment can make huge cost savings for providers. It consists of a 38 hour training course delivered in a group session based around competency skills. The scheme is successful in promoting understanding of diabetes, awareness of implications regarding diet, and the skills and knowledge required to count carbohydrates and titrate insulin accordingly with the use of DAFNE algorithms.
Autonomic phase (BM 2.8-4mmol)
Neuroglycopenic stage (BM <2.8mmol)
