ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR

ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR
ST LUKE’S PRIMARY SCHOOL BEHAVIOUR AND DISCIPLINE POLICY USE
ST LUKE’S UNIVERSITY HEALTH NETWORK PHLEBOTOMY COMPETENCY 2012 DIRECTIONS




Contents



St Luke’s Hospice Diabetic Guidelines











Contents


1. Guidance for testing of patient blood glucose during inpatient stay

2. Management of elevated blood glucose results in known diabetic patients

3. Management of elevated blood glucose results in non diabetic patients

4. Sick day guidance for the known diabetic patient

5. Management of the unwell & hyperglycaemic diabetic patient

6. Tailoring the use of glucose lowering therapy in the end of life setting

7. Management of diabetes in the last few days of life

8. Management of hypoglycaemia





Contact Details for Diabetic Team at Derriford Hospital


Diabetic Specialist Nurse:

Diabetes Registrar: Bleep 89535

Diabetes Smart Phone: Currently manned Mon-Fri 9-5: 07851 910096

Out of hours emergency advice: Medical registrar on Call via DGH switchboard
















First drafted 2012. Last reviewed February 2017 by Dr Jeff Stephenson






Guidance for testing of patient blood glucose during inpatient stay




The overall aim of monitoring during admission is to provide an appropriate level of monitoring and intervention according to the patients’ stage of illness and to avoid and detect metabolic

de-compensation and diabetic related emergencies.



ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR


1.




Management of elevated blood glucose results in known diabetic patients


Is the patient taking steroids?


If symptomatic, fasting blood glucose >15mmol/l or out with their own pre-set targets liaise with the diabetes team to optimise management



ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR

Yes

No


ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR



Management of elevated blood glucose results in non diabetic patients



Random blood glucose on admission found to >15mmol/l




ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR 3.






Sick day guidance for the known diabetic patient





Type 2 Diabetes that are diet controlled or taking metformin














Type 2 Diabetes that are on a sulphonylurea and/or insulin or GLP1 agonist
















Type 1 Diabetes on Insulin

















4.





Management of the unwell & hyperglycaemic diabetic patient



ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR

5.


Tailoring glucose lowering medication in the end of life setting

Recently diagnosed as in the end of life phase, expected prognosis of one year



Unstable or advanced disease, expected prognosis of one to two months















Patient rapidly deteriorating and prognosis one to two weeks


















U

6.

se of oral glucose lowering therapy and insulin in the end of life setting

Metformin


Sulphonylureas


Pioglitazone


Gliptins


GLP-1 Analogues


Insulin


  • Review dose according to changing renal function


  • Withdraw if egfr <30ml/l



  • Review if gastrointestinal disease is present


  • Review if dietary intake is reduced or significant weight loss

  • Review dose with deteriorating renal function

  • Review dose with deteriorating liver function, at risk of hypoglycaemia


  • Should only be prescribed if clear benefits can be identified


  • Review doses as renal function deteriorates


  • Some gliptins can be used in all stages of renal disease


  • Higher risk of hypoglycaemia if combined with sulphonylurea


  • Withdraw if abdominal pain or pancreatits develops


  • Review if significant weight loss

  • Accumulates in renal failure so dose reduction likely to be needed


  • Risk of hypoglycaemia to be reassessed as eating patterns change


  • Simplest regimen is once daily



Management of diabetes in the last few days of life



ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR


NB: Own background insulin or medicated insulin accumulates in renal failure so be aware of lower doses or needed or to stop insulin altogether


Management of hypoglycaemia


Overall aim is to prevent hypoglycaemia as symptoms are more unpleasant than hyperglycaemia

Glucose targets are a guidance and may need to be individualised based on patients lower limit for symptoms

Rationalise glucose lowering therapy in the end of life setting

Assess the influence of opiates, pain and other symptoms are having on appetite

ST LUKE’S HOSPICE DIABETIC GUIDELINES CONTENTS 1 GUIDANCE FOR 8.





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