Oxford Handbook of Diabetes Nursing
etc.
Second Edition
Questions & Answers from this book
Questions and answers are connected to the referenced book and its available source material.
Chapter 1: Classification of diabetes
In which situations should HbA1c not be used for diagnosing diabetes?
HbA1c should not be used to diagnose diabetes in children and young people, when type 1 diabetes is suspected, during acute illness or after severe trauma or a cardiovascular event, or in pregnancy. It is also avoided in people with end-stage renal disease, acute pancreatic damage or pancreatic surgery, those taking medications that can rapidly raise blood glucose such as steroids or antipsychotics, and people with HIV on certain antiviral treatments. Results should be interpreted with caution in conditions affecting red blood cell lifespan, such as anaemia or haemoglobinopathies.
What are the recommended diagnostic thresholds for diabetes using fasting plasma glucose, random plasma glucose, and HbA1c?
The WHO-based thresholds are: fasting plasma glucose 7.0 mmol/L or higher, random plasma glucose 11.1 mmol/L or higher, and HbA1c 48 mmol/mol (6.5%) or higher. If the person has classic symptoms, one abnormal result is enough; without symptoms, the abnormal result must be confirmed on a second occasion.
Chapter 3: Type 1 diabetes
What is the relative risk of microvascular and macrovascular complications in people with diabetes compared to those without?
Based on cohort studies, people with diabetes have a relative risk of microvascular complications that is at least 10 to 20 times higher than people without diabetes, while the relative risk of macrovascular complications is 2 to 4 times higher.
According to the chapter, what is the recommended reassessment interval for a person at moderate risk of type 2 diabetes (based on risk score and glucose levels)?
The recommended reassessment interval is every 3 years for a person at moderate risk of type 2 diabetes.
Chapter 4: Dietary management of diabetes
What are the key components of the DiRECT weight management programme and what were the remission rates at 2-year follow-up?
The DiRECT programme is a primary care-led intensive weight-management intervention involving total diet replacement of 825–853 kcal/day for 3–5 months, followed by stepped food reintroduction and structured support for long-term weight-loss maintenance, for people with type 2 diabetes diagnosed within the previous 6 years. At 2-year follow-up, 65% of those who maintained at least 10kg weight loss were still in remission, but only 24% of the intervention group maintained that level of weight loss.
What are the recommended physical activity guidelines for people with type 2 diabetes as stated in this chapter?
The chapter recommends at least 150 minutes per week of moderate to vigorous aerobic activity, or more than 75 minutes per week of vigorous activity spread over at least 3 days with no more than 2 consecutive inactive days. It also advises adding 2 to 3 sessions of resistance, flexibility, or balance training, and interrupting sitting every 30 minutes with light or vigorous movement.
Chapter 5: Insulin use in diabetes
What are the sick day rules for a person with type 1 diabetes using an insulin pump when they have significant ketones (blood ketones 1.5–3.0 mmol/L) and blood glucose above target?
Do not stop or suspend the pump. Give 10% of the total daily dose (TDD) as a bolus every 2 hours, adding the usual insulin-to-carbohydrate ratio if eating, and increase basal insulin by 30% using a temporary basal rate. Sip sugar-free fluids and check blood glucose and ketones regularly, and go to hospital as an emergency if you vomit, cannot keep fluids down, or cannot control glucose or ketones.
According to the case study, what initial management steps are recommended for a young adult presenting with diabetic ketoacidosis (DKA) and suspected type 1 diabetes?
The initial recommended steps are to manage the DKA with a fixed-rate intravenous insulin infusion and IV fluids, while also commencing long-acting insulin and continuing it alongside the IV infusion; urgently refer to the inpatient diabetes team; take blood for C-peptide, paired glucose, and autoimmune antibody tests; and convert to a regular subcutaneous insulin regimen once the DKA has resolved.
Chapter 6: Continuous subcutaneous insulin infusion
What should be done with the pump if a person on CSII is admitted to hospital and cannot self-manage?
If a person on CSII is admitted to hospital and cannot self-manage, the pump should be removed and insulin should be given by an alternative method, such as intravenously or via a pen device, until the person’s condition and ability to self-manage return. The pump should be stored in a safe place or sent home with a relative until needed.
How is the starting basal rate calculated when commencing insulin pump therapy, and what is the recommended initial reduction?
When commencing insulin pump therapy, the total daily background insulin dose from the previous regimen is reduced by 20–25%. The remaining dose is divided by 24 to give the hourly starting basal rate, programmed initially as one flat rate.
What are the advantages and disadvantages of continuous subcutaneous insulin infusion (CSII) compared to insulin injections?
Compared with insulin injections, CSII offers more consistent and better-absorbed insulin delivery, fewer needle injections, flexible basal delivery around activity or illness, more precise small dose adjustments, and improved patient experience and satisfaction. Its disadvantages are that the user must be attached to the pump almost continuously, there is an infection risk if the cannula is not changed every 2–3 days, a higher risk of DKA if delivery is interrupted, day-to-day practicalities can be challenging especially for new users, and it costs the NHS more than pen/injection delivery.
Chapter 7: Assessment of glycaemia and management of non-urgent hyperglycaemia
What did the ACCORD study emphasize regarding glycaemic management in type 2 diabetes?
The ACCORD study emphasized that glycaemic management in type 2 diabetes should balance optimal glycaemic levels with avoidance of hypoglycaemia, because both hyperglycaemia and hypoglycaemia carry short- and long-term risks.
What is the legacy effect of early intensive blood glucose management as shown in the 44-year follow-up of the UKPDS?
At the 44-year follow-up of the UKPDS, early intensive blood glucose management showed a legacy effect of reducing microvascular complications and improving clinical outcomes.
Chapter 8: Psychological issues in people living with diabetes
Under what circumstances is HbA1c not suitable for diagnosing diabetes?
HbA1c is not suitable for diagnosing diabetes in children and young people, suspected type 1 diabetes, those who are high risk or acutely ill (e.g. requiring hospital admission), people taking medications that rapidly raise glucose (e.g. steroids, immune checkpoint inhibitors), acute pancreatic damage including pancreatic surgery, and pregnancy.
What are the suggested capillary blood glucose targets for people with moderate or severe frailty?
For people with moderate or severe frailty, the suggested capillary blood glucose targets are 6.7 to 11.0 mmol/L.
Chapter 9: Ongoing care for people with diabetes
What are the eligibility criteria for continuous glucose monitoring (CGM) in people with type 2 diabetes according to NICE?
For people with type 2 diabetes, NICE advises considering CGM for those on multiple daily doses of insulin if any of the following apply: recurrent or severe hypoglycaemia; impaired hypoglycaemia awareness; a condition or disability, including learning disability or cognitive impairment, that prevents capillary self-monitoring but allows CGM use; a requirement to self-monitor capillary glucose at least eight times a day; or being insulin-treated and needing a care worker or healthcare professional to monitor blood glucose.
What are the HbA1c targets for adults with type 2 diabetes managed by lifestyle and diet alone or with a single medication not associated with hypoglycaemia, and for those on a medication associated with hypoglycaemia?
For adults with type 2 diabetes who are managed by lifestyle and diet alone, or lifestyle and diet combined with a single medication not associated with hypoglycaemia, the HbA1c aim is 48 mmol/mol or less. For adults with type 2 diabetes on a medication associated with hypoglycaemia, the HbA1c target is below 53 mmol/mol.
Chapter 10: Macrovascular complications of diabetes: prevention and management
According to the chapter, what long-term complications of diabetes can regular review and individualized target attainment help prevent or delay?
According to the chapter, regular review and individualized target attainment help prevent or delay long-term complications of diabetes including cardiovascular disease, heart failure, neuropathy, retinopathy, nephropathy, sexual health dysfunction, autonomic neuropathy, and emotional distress. The chapter states that overwhelming research and real-world evidence underline this need.
What is the purpose of cardio-renal-metabolic clinics mentioned in the chapter?
Cardio-renal-metabolic clinics aim to provide holistic care for the heart, kidneys, and diabetes in a single joined-up review. They exemplify a 'one-stop shop' model of care delivery that lets a person access all health care essentials in one visit, reducing the burden of multiple appointments and promoting continuity of care.
Chapter 12: Acute complications of diabetes
According to the chapter, what is the prevalence of heart failure in people with diabetes compared to the general population, and what does this suggest?
Heart failure prevalence is four times higher in people with diabetes than in the general population, which suggests that diabetes plays a pathogenetic role in its development.
What is the definition of atherosclerotic cardiovascular disease (ASCVD) as provided in the chapter?
ASCVD is defined as coronary heart disease (CHD), cerebrovascular disease, or peripheral arterial disease (PAD), and it is the leading cause of morbidity and mortality for people with diabetes.
Chapter 13: The older person with diabetes
What are the priorities for managing diabetes in a person approaching the end of life, and what glucose range is suggested by TREND guidelines?
Priorities are to keep the person safe, avoid osmotic symptoms, hypoglycaemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycaemic state (HHS). TREND guidelines suggest glucose levels no less than 6 mmol/L and no more than 15 mmol/L, with allowance for individualization following end-of-life planning review.
What are the risks of over-intensification of therapies in frail older people with diabetes?
Frail older people with diabetes are unlikely to benefit from treatment intensification and are more likely to experience its side effects. These include hypoglycaemia, falls, adverse drug effects, weight loss that can worsen frailty, and complications related to comorbidities and shortened life expectancy.
Why is hypoglycaemia particularly dangerous in older persons with diabetes?
Hypoglycaemia is especially dangerous in older persons because age-related blunting of adrenergic warning signs means blood glucose can drop much lower before symptoms appear. Also, neuroglycopenic symptoms like confusion and sleepiness may be mistaken for cognitive impairment, and frailty increases the risk of falls and injury from a hypo.
Chapter 14: Female health and diabetes
What are the recommended treatments and screening measures for women with PCOS according to the Oxford Handbook of Diabetes Nursing?
The Oxford Handbook of Diabetes Nursing recommends weight optimization through diet and physical activity for women with PCOS, with metformin as the usual pharmacological treatment. All women with PCOS should be supported with lifestyle optimization and screened regularly for type 2 diabetes.
What is the prevalence of female sexual dysfunction in women with type 2 diabetes according to the meta-analysis cited in the chapter?
According to the cited meta-analysis, the prevalence of female sexual dysfunction in women with type 2 diabetes is 70.03%.
Chapter 15: Diabetes in pregnancy
What is the recommended HbA1c target for women with pre-existing diabetes before conception, and what is the recommended dose and duration of folic acid supplementation?
The recommended HbA1c target is 48 mmol/mol or lower before conception. Folic acid should be prescribed as 5 mg daily for at least 3 months before conception and continued until 12 weeks of pregnancy.
Why is preconception care important for women with pre-existing diabetes, and what are the specific risks to the baby if blood glucose levels are not well controlled before and during early pregnancy?
Preconception care is important because organ development and birth defects can occur very early in pregnancy, often before a woman knows she is pregnant. If blood glucose is not well controlled before and in early pregnancy, babies of women with diabetes are about five times more likely to be stillborn and twice as likely to have a major congenital anomaly, and there are also higher risks of miscarriage, preterm delivery, and macrosomia. Achieving an HbA1c of 48 mmol/mol or less before conception is recommended to reduce these risks.
Chapter 17: Other important areas of diabetes care
What are the risk factors for gestational diabetes mellitus that should be assessed at the booking appointment?
At the booking appointment, assess all pregnant women for these GDM risk factors: BMI above 30 kg/m2, previous macrosomic baby over 4.5 kg, previous gestational diabetes, family history of diabetes in a first-degree relative, and ethnicity with a high prevalence of diabetes. If any risk factor is present, offer a 75g 2-hour oral glucose tolerance test at 24 to 28 weeks' gestation; for previous GDM, offer early testing as soon as possible after booking.
What are the diagnostic thresholds for gestational diabetes mellitus using a 75g 2-hour oral glucose tolerance test?
For a 75g 2-hour oral glucose tolerance test, gestational diabetes mellitus is diagnosed if fasting plasma glucose is 5.6 mmol/L or above, or if the 2-hour plasma glucose is 7.8 mmol/L or above.
Chapter 18: Diabetes care delivery
How does the handbook recommend adjusting insulin therapy for patients with diabetes who are fasting during Ramadan?
The handbook recommends basal (long-acting) insulin as the preferred initial formulation, reducing the dose by 20% and taking it at iftar. Rapid-acting insulin doses should omit the lunchtime dose and be taken twice daily with the suhoor and iftar meals. For mixed insulin, consider reducing doses based on blood glucose readings and dietary patterns at iftar and suhoor.
According to the chapter, what are the criteria for commencing a variable-rate intravenous insulin infusion (VRIII) in surgical patients?
The chapter lists these criteria for starting a VRIII in surgical patients: type 1 diabetes (including insulin pump users) who will miss more than one meal; type 1 diabetes whose long-acting insulin was not given; type 2 diabetes who will miss more than one meal with a capillary blood glucose above 12 mmol/L; most patients having emergency surgery; patients with HbA1c of 69 mmol/mol or higher should be considered; and any surgical patient going to critical care with blood glucose above 10 mmol/L should have a VRIII commenced.
What is the recommended procedure for transitioning a patient with type 1 diabetes from VRIII to subcutaneous insulin after surgery?
For a patient with type 1 diabetes, transition from VRIII to subcutaneous insulin should be made when the next meal-related insulin dose is due. Give the subcutaneous insulin with the meal and stop the VRIII 30 minutes later. If the long-acting basal insulin was stopped perioperatively in error, keep the VRIII running until that basal dose has been given.
You may also be interested in
Anatomy Physiology by Elaine N. Marieb, Katja N. Hoehn
Elaine N. Marieb and Katja Hoehn
60 questions
Middle Range Theory for Nursing
Mary Jane Smith, PhD, RN, FAAN,Patricia R. Liehr, PhD, RN
40 questions
Oxford Handbook of Adult Nursing, Third Edition
Unknown
37 questions
Fundamentals of Pharmacology: An Applied Approach for Nursing and Health
Alan Galbraith ... [et Al.].
36 questions