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Adult Safeguarding Level 1 Training for Corporate Induction

© University Hospitals of North Midlands

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Alcohol withdrawal assessment flowchart 

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Alcohol withdrawal assessment flowchart 

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Revalidation - The Nursing and Midwifery Council

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Revalidation is the process that all nurses, midwives and nursing associates need to go through to renew their registration with the NMC.

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Cardiac monitor

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https://youtu.be/7-f1OG7I0Ug

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Philips IntelliVue Patient Monitoring - Basic Operation

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critical medication list and where to find them 

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critical medication list and where to find them 

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http://uhnm/media/11581/critical-meds-list-update-08-1-2021-2.pdf

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https://youtu.be/wZAjVQWbMlE

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What Is Diabetes? | 2 Minute Guide | Diabetes UK

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https://youtu.be/C3AQIfgthh4

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If you have type 1 diabetes, your blood sugar is too high because your body can't make a hormone called insulin.

Fewer than one in 10 people in the UK who have diabetes have type 1 diabetes. There is nothing you can do to prevent yourself or others developing type 1 diabetes. The exact causes are not known.

Although it's often diagnosed in childhood, people can develop type 1 diabetes at any age. You are at a slightly higher risk of type 1 diabetes if your mother, father, brother or sister has it.

Insulin is the main treatment for type 1 diabetes. You can't live without insulin injections or using an insulin pump. Checking and managing your blood sugar levels is important to help you reduce your risk of serious short or long-term health problems. These are called diabetes complications.

There is currently no cure for type 1 diabetes, but we're funding lots of research to help find new treatments and a cure.

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If you have type 1 diabetes, your blood sugar is too high because your body can't make a hormone called insulin. Fewer than one in 10 people in the UK who have diabetes have type 1 diabetes. There is nothing you can do to prevent yourself or others developing type 1 diabetes.

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http://uhnm/media/11581/critical-meds-list-update-08-1-2021-2.pdf

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https://youtu.be/4SZGM_E5cLI

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Type 2 diabetes is the most common type. It is high blood sugar levels due to your body not making enough of a hormone called insulin, or what it makes not working properly — known as insulin resistance.

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What is the difference between type 1 and type 2 diabetes?

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What is the difference between type 1 and type 2 diabetes?

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https://www.diabetes.org.uk/diabetes-the-basics/differences-between-type-1-and-type-2-diabetes

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Diabetes (otherwise known by the scientific name diabetes mellitus) is a complicated condition and there are many different types of diabetes. Here we’ll take you through everything you need to know. What is diabetes? Diabetes is a serious condition where your blood glucose level is too high. It can…

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https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes

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The presence of high levels of ketones in the bloodstream is a common complication of diabetes, which if left untreated can lead to ketoacidosis

Ketones build up when there is insufficient insulin to help fuel the body's cells.

High levels of ketones are therefore more common in people with type 1 diabetes or people with advanced type 2 diabetes.

If you are suffering from high levels of ketones and seeking medical advice, contact your GP or diabetes healthcare team as soon as possible.

What are ketones?

Ketones are an acid remaining when the body burns its own fat.

When the body has insufficient insulin, it cannot get glucose from the blood into the body's cells to use as energy and will instead begin to burn fat.

The liver converts fatty acids into ketones which are then released into the bloodstream for use as energy.

It is normal to have a low level of ketones as ketones will be produced whenever body fat is burned.

In people that are insulin dependent, such as people with type 1 diabetes, however, high levels of ketones in the blood can result from taking too little insulin and this can lead to a particularly dangerous condition known as ketoacidosis

How do I test for ketones?

Ketone testing can be carried out at home.

The most accurate way of testing for ketones is to use a blood glucose meter which can test for ketones as well as blood glucose levels.

You can also test urine for ketone levels, however, the testing of urine means that the level you get is representative of your ketone levels up to a few hours ago.

Who needs to be aware of ketones?

The following people with diabetes should be aware of ketones and the symptoms of ketoacidosis:

Anyone dependent on insulin - such as all people with type 1 diabetes

People with type 2 diabetes that are taking SGLT2 inhibitors (such as Forxiga, Invokana and Jardiance)

It is essential to know what the symptoms are, and when you should test for ketones. Finding high levels of ketones present in your urine is a sign that the management of your diabetes needs adjusting.

Ketone testing will be important within pregnancy for anyone with diabetes on insulin. Pregnant women with type 2 diabetes or gestational diabetes that is not treated with insulin should contact their health team if experiencing the symptoms of ketoacidosis.

Ketones are a compound that can provide the body with energy. Ketones are produced when the body breaks down fats and protein. The usual reason for ketones being produced is when the body has used up its stores of sugar.

The NHS states that without sugar available, the body needs to find energy from another source, so it breaks down fat to make ketones for energy.

In type 1 diabetes, there is another reason why ketones are produced - high blood sugar or hyperglycemia Strictly speaking, it's actually the lack of insulin for why ketones are produced in type 1 diabetes.

The body has loads of energy in the form of sugar, but without having insulin, the glucose can't get into the cells to provide energy. As a result, the body switches to providing a different means of energy - ketones.

As with many things in the body, ketones are safe as long as the body doesn't produce too much. Long term research studies, such as an 8 year study carried out by Johns Hopkins Children's Center, have showed that ketones are not inherently dangerous at low levels.

For most people, high ketone levels are relatively rare. But people with type 1 diabetes, however, are at a greater risk, especially if blood glucose levels go too high.

Ketoacidosis is a dangerous state which happens if ketone levels become high. The signs of ketoacidosis include dehydration, laboured breathing and vomiting. Ketoacidosis, because it's dangerous, should be treated as an emergency and calling for medical help is advised.

You can test for ketones and this is something which people with type 1 diabetes can find useful. Diabetes advise ketone testing for people with type 1 diabetes during illness if blood glucose levels go over 15 mmol/L.

Ketone tests can be done with urine test strips and some special blood glucose meters also test for ketones. If high ketone levels won't come down, contact your health team for advice.

Download a FREE ketone levels chart for your phone, desktop or as a printout.

Ketones and weight loss

As noted above, ketones are produced when the body burns fat. Therefore people that are losing a significant amount of weight may experience higher than normal ketone levels.

Ketone testing has also become used by people with type 2 diabetes on ketogenic diets to assess whether they are burning fat effectively. Use of ketone testing in this way is not recommended by the NHS and so ketone testing strips prescribed by doctors are not to be used for this purpose.

Ketogenic diets are not usually recommended for people with insulin dependent diabetes as aiming for higher ketone levels could present a higher risk of ketoacidosis occurring.

When should I test for ketones, and how will this affect the management of my diabetes?

The following information is of relevance to people who need to take insulin.

Blood glucose levels rise above 17 mmol/L

Blood glucose levels are consistenly above 13 mmol/L

If blood glucose levels rise in response to illness

If you notice symptoms of ketoacidosis such as vomiting or suffering from diarrhoea

If you record high levels of ketones, contact your health team immediately for advice on how best to manage your diabetes.

I think I might have diabetic ketoacidosis, how would I know?

If you are suffering from diabetic ketoacidosis the early signs are likely to include:

Stomach pains

Nausea and/or vomiting

Breathlessness

Breath that smells fruity

In this instance, call your doctor as soon as possible as ketoacidosis is an extremely severe condition.

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The presence of high levels of ketones in the bloodstream is a common complication of diabetes, which if left untreated can lead to ketoacidosis.

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The presence of high levels of ketones in the bloodstream is a common complication of diabetes, which if left untreated can lead to ketoacidosis Ketones build up when there is insufficient insulin to help fuel the body's cells. High levels of ketones are therefore more common in people with type 1 diabetes or people with advanced type 2 diabetes.

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https://www.diabetes.org.uk/guide-to-diabetes/complications/diabetic_ketoacidosis

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Diabetic ketoacidosis, also known as DKA, is when there is severe lack of insulin in the body. This means the body can't use sugar for energy, and starts to use fat instead. When this happens, chemicals called ketones are released. If left unchecked, ketones can build up and make your blood become acidic - hence the name acidosis.

Diabetic Ketoacidosis (DKA) is a serious condition that affects people with type 1 diabetes, and occasionally those with type 2 diabetes (although they are more likely to be affected by Hyperosmolar Hyperglycaemic State (HHS)).

Some children and adults who don't realise they have type 1 diabetes don't get diagnosed until they are very unwell with DKA. It is important to be able to spot the signs and symptoms of DKA so that it can be treated quickly.

DKA is serious if it is not treated fast so these are some of the warning signs to look out for. Share this information with friends, relatives or anyone who looks after children, like teachers and childminders. This is so that they will be able to spot the symptoms of DKA, too.

Here Kate tells us about when her son Llewis became seriously ill with DKA and was diagnosed with type 1 diabetes soon after.

What are the signs and symptoms of DKA?

The signs of DKA include:

high blood sugar levels

being very thirsty

needing to pee more often

feeling tired and sleepy

confusion

blurred vision

stomach pain

feeling or being sick

sweet or fruity-smelling breath (like nail polish remover or pear drop sweets)

passing out.

Although most common in people with type 1 diabetes, people with type 2 diabetes can sometimes develop DKA. If you notice high blood sugar levels and spot any of the signs below it's very important to get urgent medical help.

In her video Kate mentions the 4Ts which are the four most common signs of type 1 diabetes. They are:

Toilet - Going to the toilet a lot, bed wetting by a previously dry child or heavier nappies in babies.

Thirsty - Being really thirsty and not being able to quench the thirst.

Tired - Feeling more tired than usual.

Thinner - Losing weight or looking thinner than usual.

The early signs of DKA can often be treated with extra insulin and fluids if it is picked up quickly. But if it isn't, DKA needs hospital treatment and can be life-threatening.

These symptoms are sometimes referred to as a 'diabetic attack', but this can also refer to other things, such as hypoglycaemia. You might notice these signs developing over 24 hours but they can come on faster, especially in children or if you use a pump. If you spot any of these symptoms it is a sign that you need to get some medical help quickly.

Checking ketones and blood sugar

Blood testing

Check your blood sugar straight away if you have any of the signs of DKA.

If your blood sugar is high, check for ketones. You can check your blood or your urine for ketones. A blood test will show your ketone levels in real time but a urine test will show what they were a few hours ago.

If you have type 1 diabetes you should get either a blood ketone monitor or urine testing strips for free from the NHS. If you have high ketone levels in your blood and suspect DKA, you should get medical help straight away.

When to get help with DKA

DKA is serious and must be treated in hospital quickly. Left untreated, it could lead to a life-threatening situation.

Treatment of DKA includes:

Being given insulin through a vein

Being given fluids through a vein to rehydrate your body

Being given nutrients through a vein to replace any you've lost

You'll also be closely monitored to make sure there are no serious problems with your brain, kidneys or lungs.

You'll be able to leave hospital when you're well enough to eat and drink and tests show a safe level of ketones in your body.

What can you do to avoid DKA?

You can help avoid DKA by monitoring your blood sugar levels regularly and altering your insulin dose in response to your blood sugar levels and what you eat.

Your blood sugar levels could be higher than normal when you are unwell. So, it's a good idea to work with your healthcare team to come up with some sick day rules for when you are ill. You may need to drink more fluids, take more insulin and check your blood sugars more than you would usually. The amount of extra insulin needed will vary from person to person. Your diabetes team will help you to work out the correct dose for you (or your child).

It is still a good idea to contact your GP or diabetes team if:

You feel fine but are getting higher than usual readings for blood glucose and ketones.

You feel unwell but your blood glucose and ketones are only slightly higher than normal.

"The experience [of having DKA] has taught me that it's so important to listen to your body. No matter how many HCPs you visit, whether they're a GP or a diabetes specialist or a family friend who works in the field, you know your body and you know what feels right and what doesn't feel right. When it comes to diabetes, it's so important to trust your instincts."

Amber, 21, had DKA

What causes DKA?

For some people, becoming suddenly very ill with DKA can be what leads them to finding out they have type 1 diabetes in the first place.

If you have already been diagnosed with diabetes, the causes of DKA can include:

being ill with a chest infection, flu, Urinary Tract Infection (UTI) for example

high blood sugar levels caused by a growth spurt or puberty

not taking your insulin or missing doses

surgery or an injury

high blood sugar caused by having your period.

Sometimes, there isn't always an obvious trigger for DKA which can be worrying and confusing. But if you suspect you or your child has DKA it is important to get medical help straight away.

If you are concerned about any aspect of managing diabetes, you can always call our helpline for support on 0345 123 2399. Alternatively, you can head over to our forum where there are many people willing to offer support and share their experiences of diabetes.

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Diabetic ketoacidosis, also known as DKA, is when there is severe lack of insulin in the body. This means the body can't use sugar for energy, and starts to use fat instead.

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https://youtu.be/Ht9RuSP4YZc

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Understanding The Venous Blood Gas (VBG): Components, Sampling Sites, Physiology, Converting To ABG.

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This is the link to ESR where you will find all the training for MAND and STAT

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Home - ESR Hub - NHS Electronic Staff Record

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As the workforce solution for the NHS, the Electronic Staff Record (ESR) supports the delivery of national workforce policy and strategy. The ESR Hub provides access to the NHS ESR and useful online resources.

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Arterial blood gas interpretation in 5 min

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https://youtu.be/tTu9zgkdA0k

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Philips IntelliVue Patient Monitoring - Understanding Alarms

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All of these area's need to be covered when completing revalidation 

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All of these area's need to be covered when completing revalidation 

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Understand the revalidation requirements and how you can meet them