WorksheetsDiabetes and Palliative Care - Revision!
Total questions: 10
Worksheet time: 6mins
General glycaemic aims for palliative care patients at the end of life are:
no glucose level <4 mmol/L
no glucose level >15 mmol/L
no glucose level >10 mmol/L
no glucose level > 7.8 mmol/L
How many recognised stages of end-of-life care are there?
3
4
2
5
Deprescription, simplification and even withdrawal of cardio-protective therapies (e.g. aspirin, ACE i, statins) can be considered at which earliest stage of prognosis?
Months
Weeks
Year plus
Days
Which are the described pharmacotherapies in the MEMs Inpatient Glycaemic Care guideline?
Basal bolus / prandial regimen
GIK regimen
Variable rate intravenous insulin infusion (VRIII)
Basal plus regimen
For the basal bolus regimen, what is the total daily insulin dose expressed in unit/kg/day that is most appropriate for a cachexic palliative care patient?
0.2 u/kg/day
0.4 u/kg/day
0.1 u/kg/day
0.6 u/kg/day
The Basal plus regimen is best suited for patients who are:
Nil by mouth
Tolerating orally well
Poor oral intake
On established NG tube feeding
Your patient has CKD 5 and is on a basal bolus regimen. He is still having hyperglycaemia and you wish to start him on a top up scale. Which top up scale is most appropriate?
Top up scale A
Top up scale B
Top up scale C
In the last days of life, the following measures are appropriate EXCEPT for:
Stop monitoring blood glucose if on diet controlled DM
Stop monitoring BG and stop insulin in Type 1 DM
Prescribe OD dosing of insulatard and monitor BG at dinner time (previously on insulin)
Stop insulin in Type 2 DM and monitor BG; offer short acting insulin according to pre-determined top up scale
Which are the correct pairs of medication and their hypoglycaemic risk?
Metformin - no risk
Gliptins - low risk
Sulphonylureas - low risk
Glargine - moderate risk
Regarding CKD patients, the following statements are correct
Insulin requirement is increased in insulin treated patients undergoing haemodialysis
Insulin requirement is increased in insulin treated patients undergoing peritoneal dialysis
Metformin should be avoided in CKD stage 4
Reduce dose of Vildagliptin to 50mg OD in CKD stage 4
