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maybe. Can you see that? Yes. We can get a fence. Okay. How they learn about I, um I think it's, um for I can't say fetuses and peck on people in the room. But, um I mean, I'm sure you knew May, um I, um the inpatient by BS, my sisters and the colds by myself. America last, um So I have the last, um, thank you for the invitation to speak at my diabetes I The decay on this is for adults on, but I know I'm a very where there's nurses on doctors on, so I'll try and, um, make a as wide for both filters on nurses for your mind off your DKA. So everybody should know what diabetic ketoacidosis is as, um, that's whenever the blood sugars are consistently high or in some cases when they're not so consistent, like, hey, we shall focus on shortly on the end. The border them produces this product called ketones and then have a build up of best, and it gets placed less. And then the body becomes acidotic and it becomes on whale so he can get decay. Before, our answer would have always been tight ones But we are seeing a lot more Type two's come in and take a um Oh, I still got your titles page coming up. I'm even on. I wonder why do I just trying to stand your great screen share And this started again? Yep. Stop screen share. So go on a screen share again. So, what can you see? Nice thing. Can you cut me down on? Yeah. Yeah, that's that's night. Okay, So you scared me there, and he was saying he gets DKA. So before we were saying that I've been tight on this, but my we have lots more tape to use coming in on the man reason for this would be assessed lovely new drug that we're using on their struggle. Be used a lot, lot more. And I because there's license for it and heart failure on and renal on this tablet, the is closed on. Ask you all tea. Um, and what this type of doors is, it makes the patient p eight the extra sugar. Um, so that's a volume too player. So when people are feeling on whale, when they're not eating and drink and they get dehydrated anyway, but if they continue to take those tablets. Them. This closes the dehydration to ask ileum. And there's research last year with stooling that that's tablet Bisley and creases. Three full breast of decay on. I'm sure most of used 38 80 have seen lots of these cases. Come on them. Take radios with DKA are with that coupon recently. Can you see me move my cursor name? Yeah. Can you animal? Very. That's great. That's okay. So these are the less off the drugs that if you want to take note that if you're Clark and your patient and or if one of the nurses flagged these less of drugs, they're called that the Fluzone. So their dad refuse on kind of fluids. And the amplitude is one and the last one. We don't really see a north flow off, but at site there, so they're they're important drugs to take note. So if any of the Mavericks say someday on the commend on these patients are dehydrated, it certainly if there are cool. But patient may still talk about their These drugs must be stopped because they were asking me if you're, um, dehydration. So how do you diagnose somebody with DKA. So most patients when they come and get a blood sugar down on the blood gas so you may have some of these patients, you know, nationality to You may have a normal blood sugar, but we'll have a very elevated blood. K 21. Um, so you had video on the blood gas and the blood gas with LSD. It whether the pH is, um, less than 7.3 under or your venous by carb as last 15. We d, um, blood Caitlin tonight before we were to use the urine. But you have your facility eight and the department my to do your blood cater one. Um, I just wanted to point out that that's very, very important that the diet news is off your D k aspect bump really early? Because if we leave the case left untreated at Spiro on, these patients could get very sick very quickly. So where any new nurses are all on do public about worrying what normal kid ones are? Um, in your books, your blood sugar stations, your books is in your department and the lead the glass. But even for the doctors as well that this should be in your books. Ever hasn't let me know because they should Benaglio boxes unless gives you a guide walk, loon or Malon hike it. Ones are so that should be on your books. Is because at compass, very scary when you're working with the money different patients and where you're working with blood sugars want as a normal or high Keitel. But this should be on your books. And if it's not going back to my so this, you should have this on your department, they should be plenty. I and they should not be a print off the the They're printer and the department because they're in color on there in color for a reason. We have the DKA on the HSS. The decay has, ah blue color three it, So that's not picked up as an HSS protocol cause it to your very different protocols. So you have copays of cards on your department and they should not be printed off from your ordinary computer. Eso this front shape tells you how to manage the patient, and then the back shape gives you your extra answered. Your viable very handsome, and you're recording off your blood sugars and your keytones and your blood gases. So how do we manage your DK's when there's ti very important things. It's your insulin on your fluids. So if you can, you get with it on the patient. A man you commenced you're fixed. Re Ansel in. So that would be the CIA MRI it offensive will be wrong. Um, I said, as the diagnosis have been firmed on, then the doctors will follow the protocol as regards to the three. Replacement on the fluid replacement is really, really important. Um, these these poor calls our old just gauge. So you have a patient in front of you and you'll make ER medical judgment cars teeth that as that's a a small adolescent, um, assay young adult as regards to fluid replacement, Or are they elderly at the risk of overloading or slipper or edema? So you have your potassium replacement, and it's very important that your potassium has monitored pickles once you start to commence your insulin. As you know, when you start to push ups and then you can push the potassium dying's what's really important. I have seen my patients of DKA some There hasn't been you need it on for a long, long time whenever you need it on the 12 ours 24 hours later, the potassiums in the boots And then there's panic stations was really important that the the you need some potassium zar monitored regularly us according to what we recommend, avoid and hypo. So monitor in your blood capillary blood sugars. Um, aren't I on when the blood glucose drops low 14? That's really, really important. The antiandroid extras according to the political and, of course, that identifying the treatment, taking the underlying cause, these patients could have infection that could have a some sort of sickness going on. So I don't find us. You know, nothing else was the cause of DKA. So this is the fax tree and some so how you work. It's no 0.1 unit per kilogram per our best on estimate we it or a week if he can get it. So say the patient is 98 kg and the the really will be at nine. Um, and of ketoacidosis have resolved then, but no eat, no drink. And then there's a variable to be answered, and that's never the the and some dose changes according to what the blood sugar is on. You'll find that up on your bike of the sheet, the top one us where the doctor prescribes effects, tree it on the books below as where the variable re it goes. So it's very important. Protocols change from time to time, but at the minute, um, that whenever the blood sugar falls below 49 that's outing 10%. When I'm saying night at 125 mils and arcus, that's the current protocol is. But I'm going to talk to you in a short time about what happens if your patient is cool. But because that changes things after basketball balloon, when the ketoacidosis have result but no eating and drink and then they changed to 5%. The extracts don't remember to prescribe all your fluids on your fluid balance chart. This is really, really important. Um, remember to continue your long acting the animal against, um, such as your mama's your Levemir your trusted bye. Um, and that's the thing. But I knew I always check whenever I'm going by and seeing all the D cases. Make sure in the long acting Lantus, Um, let's continue because as the morrow, whether these patients resolved quickly or whether the resolution stage as quite long because of new bike riding on some, because they're fighting to keep the blood sugars dying. Um, when patients start to eat, then changed to stop cut insulin. I'm in time, and I pay late in the meantime, because as a smart girl, if you don't get the time of the best rate, you will have your patient popping back into DKA and a very sick patient again. Because the's patients, um, I'm going to ask, used to take Think of a question of minority. How long do you think the halfway off intravenous sense in is like in your hands? What the answer would be? So it's actually five minutes. So it's done as you start that a be insulin. If you haven't given that patient the basal insulin, or if you haven't given that patient or something else, um, those patients have you leave them for a couple of hours content back empty DKA very right quickly. So it's really important that these patients get their subcontinent's them automate a time unused. Keep going with the underpinning confusion there. It's 60 minutes after they get out. So cut insulin for the doctors. If you're asked to do a blood gas, a 12 month might on your change over. And you think Okay, the Ryzolt Do you know what? Stop decay Particles of my mate. By the morning you'll have a DKA back in your hands again. So it's really, really important if you're asked to give you something on the tickets later. Um, just that it's really important that the patient keeps going with her at the Intervenous insulin and told the patient gets herself Cancel. Um, so the modern modern and Bs lioness, your papillary key tones, allow blood glucose. Sometimes you'll have, ah, lab blood sugar. That's from three, and it's clear in the 27 point yet, but that's the case you must get. I've been a venous locals, a way off to the lab. You could be working with a clinical status. 50 is 90 120 A. I've seen one, so it's really important that you have a lab slip. Those to see that those blood sugars are coming down, even if you have eye compelled a blood sugar that's given you agree on the 27 point. Yet for a couple hours you must still send off a lab pickles. So we say that that little's coming by and nice is slowly, um, venous phe anemic knees and Force Vietnam football picture. So it's are low blood glucose in my early ketone is until the Keto ones are less. No 0.5. You were doing your venous pH. Very carb. Um, on the time that you diagnosis there, that's one early and and it's to you early on and it's too hard and told the pH is great and then 7.3. The lab you need is on four or early on For the nurses, it's really, really important. Nystatin is you Put somebody on Teo, take a political the CNS. SoBe's is really, really important. Unnecessary. Done. If I any early signs of celebrity Dema, these patients get a lot of fluid part of their management. Um, we've had a sad case, um, where this neighborhood Emma at that happened. So it's really, really important that you do your CNS SoBe's report any changes to the doctor so they can flag up any concerns? Um, so with DKA doctors, if you can't see that your patient has resolved. And there's a couple of points that we have picked up. Make sure that the IV and some medicine fusion properly that the pumps working that the van floors working. But there's no come on that there was. Patients are definitely getting their insulin properly. Have they got their failures properly? Have the got what has been recommended? If you feel that the patients not resolving as nicely you think the consultants should be involved and they're fixed re it. Come it increased. We bit on then that must be assessed. Want to see the blood sugars coming down? Criteria for the resolution is the Caitlin slash milk point by ph is over 7.3 on your bike. Arms back up to over your team. No, I think you have changed. Um, since we've had on the minds cool. Bit on the max is well, so you may have a patient presented to the department with DKA Also has Cupid, um, on things. Combine your tight ones or your type twos or somebody on there. Recently, um ti was decay secondary to has Stoutt. I'm hey, was coma as well. These patients. You still follow up the top scaling, but there's an additional information on the back of your dick a protocol, and you'll get that on the business site. And I just took some, uh, put some best for you used to read, but go into the business area who went to diabetes on Go into the decay a kub it management and you'll see the Senate. You must six in your reviews, and it's possible. And if you think that these patients that risk off our ts turn your manias, they should not get aggressive fluid replacement because worsen off palmetto Dema. These patients also go on today, so these patients will be very answer persistent. So the my life off their blood sugars are really, really important. So the Senior Review and a Crane team should band bull to send this. These patients are identified, um, on the get last fluids. So you have somebody. He aren't risk of overload of fluid instead of the one leader bags. That's protocal is advice. You use 500 ml bags on the shoes in there, the re it that they would be given also your effects. Denson on your B is a lense Lynn on the potassium replacement of the fluid that they get that stiffness. Well, as you can see, it's half. A buying is well, so if you're not aware of that, please go went to the business area. The doctor's on deidentify that because we have quite a few, um, we will get more know coming into the monitor months with this, so it's very important you're aware of it. So I know why I can't talk on too long. So I have identified. If you keep points that I want to make sure that usually take away from this, um, margin of decay as the prompt management offer is really, really important. Great fluids on the correct baby and stuff the fixed re is it Rite Aid increased as the pumps working as your van fluids. Working um, basil insulin is still important that that's camp the one the CNS. SoBe's a really, really important to identify your slave brittle Dema early good management and the resolutions. Th If you don't mind it properly, you'll end up with a patient back and DKA again, cautious with your AB for years with patients a coup. But that's new. So be careful with those well as your elderly patients. But just be aware off the fluids that they are basing you to use with the cooler patients still being an IV answered correctly, they can sure that the pump rooms for 30 60 minutes after you gave yourself Anson worth a million prompt referral to the diabetes consultant staff Me, it or to me. Um, And there's other thing that I'm Adam there. Um, we have a lot of patients now on their own pumps. So if patients come in, they are decay. Um, on the very sick, the pump should be removed. Um, the patient should replace their line the insulin, that senate and your test on their pump to make sure that everything is okay with the pump The line on the insulin before at his turned by one again because the pump could be the reason why they haven't entered a k. Remember, when you put bring somebody's pump away, they have new insulin. So those patients from the advice from the diabetic team may need a bit of basal insulin, um, for their help with DKA management. So f you have any body in with the pump. Contact the diabetes team and they would give you advice or margin on that. Any questions? Thanks so much care. That was really interesting. I think hopefully we'll give foot. We've ever update it. Um, well, just let folk put any questions into the chart function there. Why? We've got kiwi. Those cause she's a, uh, great source of knowledge for us. Get you just from my perspective, what's the biggest thing that you think people do wrong or are reluctant to do it correctly? Um, sometimes starting to put a call come out, we bet. Slow, um, on the basal insulin. Um, so I think once a blood gases thumb, I think take a note that the patient is decay. Um, I'm starting to put call a Sanaa's, um, on the on the beers or insulin. A lot of houses bought a lot better, I must say, um, I thought so. I think starting to starting the protocol as a key at the right time on then on the words and I know you have more. So recently I may have longer stays down the meaty. So count stress the importance of the resolution stage Big and sure that the patient goes back on to it properly because there's been quite a few cases recently. Where I have went to the wards, um, or seen a patient on the patient was stopped The protocol in the middle of night or the middle of the afternoon on the patient actually checked my, um, to take a because that started the insulin at the middle on on on the pump afterwards to prevent that like time and are a real A of the high blood sugars on also monitoring off the blood. The the light relates is a key is Well, um, because everybody says I but it's just still important to make sure those potassium levels were kept on my own. Okay, Um, and he's got question there in the shop for you. It says four pieces of ours who were discharged on the secretarial a face has anyone they can call in the diet is team of ours for a base if they need, um, I ran kicks your toe. Uh eh. So so no effort site of ours won't, but I'll dock. But as to if necessary, day rolls as regards to the SGLT tea um, if you're Santa, Somebody whom with that Is that right? Ama It was someone he waas on insulin pump. So they had recent, probably ever, That they were just a wee bit nervous. Something that was quite recent. Things were given some basic advice, and I never got a tester kit in the moment, was just they weren't sure. Okay. And then the issues with the cycles. Okay, so those patients on pumps will have algorithms that they follow as regards to set a rules. New those patients on pumps is very different. So I am. Are you Are you a nurse or a doctor? Um, elevated doctors, the doctors. So ama they patients who you are on the pump them they would they have the backup off their pans. So they have this sexy day algorithm they follow, so if they are using their pump and they have keytones on, but they have some medications and they should be used and they're pan to try and get the ketone. Stein. Um so those patients should be aware of what they're sick Bay rules are through their recent treatment on. If they don't, then you send also email on They obviously need some support then if they're not comfortable, percent barrels. But those patients, the very important thing ever for you to say that was patient says they must make sure a lot of patients on pumps forget having pants and the host on whenever their pants there pump breaks down. And if no backup. So old pump patients should have the short acting medicines and a pan and the host so that they had canoes that spike up of those patients, their pumps feel that they can get their short right anomaly there. So right on insulin, it's I make sure they have a key to a meter. So say, at the weekend and we're not here. Um, there's Keitel, mayors here, and our comfort. Um, So if you're really needing the kettle mayor, you could get that one of the porters. Teo, open up and get You told me a call. All patients should on on a pump should have a key to me here. Uh, I feel, you know, bought a hammer. Really? Very much. Uh, okay. I don't think any other questions. So I think that you that enough leg. Okay. Well, sure. I found out that it has on the equations and they seem yet by sure they can speak to me. So everything's watch All the vas folks all have a good day. Your head to the fried. Less information today is excellent. Bye.