Dextrose drip and variable rate insulin infusion

(1) Give normal insulin on the night before the operation (2) Early on the day of operation start an infusion of 10 dextrose, add 20mmol potassium chloride to each litre, and run at a constant rate appropriate to the patient's fluid requirement, usually 100ml h (3) Make up a solution of soluble insulin 1 unit ml saline in a syringe and infuse intravenously by a line piggybacked to the intravenous drip by using a syringe pump. The infusion rate should normally be as shown in regimen 1, but in...

Diabetes associations for patients and health professionals

American Diabetes Association (Patient and Professional), Australian Diabetes Society (Professional), Tel 0061-9256-5462 Fax 0061-9251-8174 < www.racp.edu.au> e-mail < sneylon racp.edu.au> Diabetes UK (Patient and Professional), Tel 0044-20-7424-1000 < www.diabetes.org.uk> Canadian Diabetes Association (Patient and Professional), < www.diabetes.ca> Diabetes Australia (Patient), 1st Floor Churchill House, 218 Northbourne Avenue, Braddon ACT 2612, Australia. Diabetes New Zealand...

Insulin dose during illness or infection

During illness or infection your blood glucose level may rise, causing you to feel dry, thirsty and pass too much urine. The blood glucose is also likely to increase You MUST continue to take your normal insulin dose NEVER stop it. You may need an increased dose if your blood tests are bad. If you are vomiting, consult your doctor or the diabetic clinic at once. If you are unable to eat, take your carbohydrate portions in liquid form for example, milk, Lucozade, Ribena Test your blood twice a...

Local diabetes service advisory groups LDSAGs

Coordination of services by LDSAGs is crucial to their success. Local committees can achieve this very effectively. They should comprise representatives of local purchasing authorities (for example health authorities or primary care trusts), providers (hospital consultants and general practitioners), diabetes specialist nurses, and consumers (diabetic patients). Effective discussions in this group can substantially enhance local services which might otherwise become seriously fragmented.

Continuous subcutaneous insulin infusion CSSI

CSSI was introduced 25 years ago by workers at Guy's Hospital in London, and now the development of more reliable and more sophisticated pumps brings distinct advantages in specific indications to approximately 2 to 5 of those with Type 1 diabetes. A small improvement in overall diabetic control compared with optimised injection regimens can be achieved without necessarily aggravating or indeed actually reducing problems from hypoglycaemia. CSSI is not suitable for those with psychological or...

Symmetrical sensory neuropathy

Diffuse neuropathy affects peripheral nerves symmetrically, chiefly those of the feet and legs. It is almost always sensory, though motor involvement causing weakness, and wasting does occur rarely. Peripheral neuropathy is common in longstanding diabetic patients, but in Type 2 diabetic patients it may already be present at the onset of diabetes. Progression of neuropathy is reduced by good control of diabetes over many years. The potential of pharmacological agents to alter the course of...

Storage of insulin

In a temperate climate insulin will keep for some months at room temperature (and furthermore injections sting less if the insulin is not chilled). Refrigeration is wise for prolonged visits to a tropical climate, and is also recommended for stocks kept at home for long periods, although exposed insulin actually deteriorates very little. Insulin should never be deep frozen and should not be left in the luggage hold of an aircraft, where it may freeze. Insulin is not damaged when passing through...

Further reading

Bloom A, Ireland J. (with revisions by Watkins PJ). A Colour Atlas of Diabetes, 2nd ed. London Wolfe Publishing Ltd, 1992. Boulton AJM, Connor H, Cavanagh PR, eds. The Foot in Diabetes, 3rd ed Chichester John Wiley & Sons Ltd, 2000. Bowker JH, Pfeifer MA, eds. Levin and O'Neals the diabetic foot. St Louis Mosby, 2001. Day JL. Living with diabetes, 2nd ed. Chichester John Wiley & Sons Ltd, 2001. Dornhorst A, Hadden DR, eds. Diabetes and pregnancy. Chichester John Wiley & Sons, 1996....

Problems associated with insulin injections

Many patients develop some blurring of vision soon after starting insulin, which makes reading difficult. This is due to a change of lens refraction, and it corrects itself within two to three weeks. Patients should be advised that this may occur, both to avoid extreme anxiety which they may experience, and to stop the needless purchase of new glasses. Transient oedema of the feet is not uncommon during the first few weeks of insulin treatment. Fatty lumps at injection sites are common, and...

Clinical presentation why is diabetes so often missed

Thirst, tiredness, pruritus vulvae or balanitis, polyuria, and weight loss are the familiar symptoms of diabetes. Why then is the diagnosis so often missed Of 15 new patients with diabetes presenting in our diabetic ward for the first time with ketoacidosis, 14 had had no tests for diabetes after a total of 41 visits to their doctors. Almost all these serious cases of ketoacidosis could have been prevented. Patients do not, of course, always describe their symptoms in the clearest possible...

Conclusions

Many foot problems can be prevented, and all diabetic patients should be aware of the potential problem of foot damage. Every patient should be issued with information containing straightforward safety instructions. A good podiatrist must be available for diabetic patients. Ill-fitting shoes are the cause of many problems. New shoes should always be broken in by wearing them initially for only short periods. If the foot is in any way misshapen, for example, from bunions, hammer toes, Charcot...

Journal references

Type 1 diabetes new perspectives on disease pathogenesis and treatment. Lancet 2001 358 221-9. Barnett AH, Eff C, Leslie RDG, Pyke DA. Diabetes in identical twins a study of 200 pairs. Diabetologia 1981 20 87-93. Barrett T. Inherited diabetic disorders. CME Bulletin Endocrinology and Diabetes 1999 2 47-50. DCCT Diabetes Control and Complications Research Group. The effect of diabetes on the development and progression of long-term complications in insulin dependent...

Insulin treatment

I was like a dried tree, but you have given me new life. An Ethiopian villager, after starting insulin. The astonishing power of insulin to restore health and well-being to rapidly deteriorating newly diagnosed Type 1 diabetic patients is as remarkable now as it was in 1922. After Banting gave insulin to Elizabeth Hughes in that year, she wrote to her mother that it is simply too wonderful for words this stuff. Insulin to this day always has this effect the challenge now is to optimise control...

Time changes on longdistance air travel

There are inevitably difficulties with diabetic control for a few days. The time between injections can, with little problem, be lengthened by two to three hours twice daily. Regular blood tests should be performed and if they are excessively high around 15 mmol l or more extra soluble insulin between 4 and 8 units can be taken. If the time gap between injections is lengthened still further, a small supplementary injection of soluble insulin between 4 and 8 units is taken between the usual...