Diabetes (DM) is high blood sugar over a prolonged period.

• Type 1 diabetes, where the pancreas fails to produce enough insulin (thus formerly known as insulin-dependent diabetes). Its onset is in childhood (thus formerly known as juvenile diabetes). The cause is unknown
• Type 2 diabetes, where insulin resistance (i.e. cells fail to respond to insulin properly) (thus formerly known as non insulin-dependent diabetes, NIDDM), which can also progress to a lack of insulin. Its onset is in adulthood (thus foremrly known as adult-onset diabetes). The cause is excsesive body weight and insufficient exercise
• Gestational diabetes (GDM), see page

• 387 million people worldwide, or 8.3% of the adult population, have diabetes
• Equal rates of men and women are affected with diabetes
• 90% of diabetes is type 2
• Diabetes results in 3.2 million deaths per year
• Diabetes at least doubles the risk of death
• The global economic cost of diabetes is $612bn annually, with the USA constituting 40% of this cost
• Impaired glucose tolerance is a major risk factor for progression into full blown DM, as well as CVD

The paperwork for Diabetic chart is:

• Affix Pt label
• Instructions: Blood glucose = Glucose monitor reading (Blue or black) (mmol/L)
• Various blocks of columns are repeated for additional Date/Time. The rows include Date __/__/____, Time __:__, blood glucose mmol/L (for various sub-divided cells, including 24, 20, 16, 12, 8, 4 ___), blood glucose (GMR) mol/L, (extra) insulin type and units, hypoglycemic episodes and Tx, and urinalysis for glucose (subdivided cells for 28++++, 18+++, 3/48++, 1/28+, 1/48 trace, Nil), and Ketones

The paperwork for Pediatric insulin infusion chart is:

• Affix Pt label
• Allergies/ADR
• Weight of Pt
• Date
• ADD 50 units of ___ insulin to a 500mL 0.9% sodium chloride bag (final concentration 1 unit per 10mL)
• Date ___. Commence insulin infusion @ ___ mL/hour. Medica officer Name and Signature
• Under section Insulin infusion orders (Must be written every 24 hours or when infusion rate changed), there are various rows, under the columns Date, Time, Drug, Fluid, Rate (mL/hr), MO
• Under section Insulin infusion preparation (before commencing infusion), there are various rows, under the columns Date, Time, 1st check/Nurse sign, 2nd check/Nurse sign
• Note that, Insulin infusion must be delivered via an infusion pump. Insulin infusions are to be titrated according to a predetermined Pt specific prescription written by a Medical officer. Insulin infusion and compatible maintenance fluids must run through the same cannula
• Under section Infusion rate changes, there are various rows, under the columns Date/Time, Blood glucose level mmol/L, Infusion rate mL/hr, Potassium mmol/L, Ketones specifiy type (blood/urine). The final column is To sign when infusion rate altered (with a subdivided cell for Nurse 1, Nurse 2)
• On the reverse side, information, for IV insulin infusion for diabetic ketoacidosis - adjustment algorithm (FOR USE BY MEDICAL OFFICERS ONLY). The table indicates the change in insulin rate from the current hourly rate according to the current BGL and rate of change of BGL in the previous hour. The table itself has rows with various Current BGL (mmol/L), including >15mmol/L, 10.1-15mmol/L (when BGL first falls to <15mmol/L, first step is to add glucose to IV fluids before adjusting insulin infusion), 5.1-10mmol/L, 4.1-5 mmol/L, 3.1-4mmol/L, <3mmol/L or symptomatic hypoglycemia. The columns include Change in BGL from last hour, including No change (wihtin 0.5 mmol/L of last hour), Falling slowly Fall of 0.6-2 mmol/L/hr, Falling moderately Fall of 2-4 mmol/hr, Falling quickly Fall of >4 mmol/hr, Rising slowly Rise of 0.6-2 mmol/hr, Rising moderately Rise of 2-4 mmol/L/hr, Rising quickly Rise of >4 mmol/L/hr. For a different combination of these cells, there are different decisions to No change, Increase, or Decrease by 10%, 20%, and so forth. This chart can be found on Page 19 (of 22) of 2008-8061.pdf">this document from Children's Hospital at Westmead
• * Recheck BGL in 30 mins. NB: Call the endocrinologist on call if acidosis is not improving
• Maintenance fluids if BGL >15mmol/L is 0.9% sodium chloride; BGL >8-15 mmol/L is 0.45% sodium chloride 500mL & 5% dextrose with 20 mmol Potassium; BGL <8 mmol/L is 0.45% sodium chloride 500mL & 10% dextrose with 20mmol Potassium. The glucose concentration of th emaintenance fluids should be increased before the insulin infusion is decreased
• How to increase the concentration of glucose in commonly used IV fluids, includes the columsn Fluid type (500mL bag), How much 50% glucose to add, Total glucose concentration. All types are sodium chloride 0.45%. For 25mL to add, 5% concentration; for 50mL to add, 7.5% concentration; for 75mL to add, 10% concentration

The paperwork for Continuous subcutaneous insulin infusion (pump) programming order form includes:

• Affix Pt label
• Type of insulin
• Pump brand
• Total units of insulin loaded into reservoir: ___ units (See NSW Health subcutaneuous insulin prescribing chart for Insulin prescription)
• Under the section Current pump settings, there are various rows, under 3 columns, including:
  • Basal rates, which is subdivided into Start time 00:00, and units/hour. The last row states Maximum basal rate ___ units/hr
  • Meal bolus, which is subdivided into Start time 00:00, and grams CHO/units of insulin. The last row states Maximum bolus rate ___ units/hr
  • Correction factors, Correct if BGL > ___mmol/L, which is subdivided into Start time 00:00, and mmol/L decrease per 1 unit of insulin
• The section Current pump setings continues, with Duration of insulin action ___ hours. Target blood glucose ___ mmol/L. Authentication, including Medical officer name, signature, date __/__/___, review date __/__/____
• Please ensure a referral is made to Diabetes educator, Dietitian and Endocrine team
• Table with various rows, with the columns Date/Time __/__/____ __:__, blood glucose level (mmol/L), meal CHO (grams or exchanges), meal bolus - MB (insulin units), correction bolus - CB (insulin units), slighted pump dose record (RN, RM, accredited EN & a patient/parent to witness each change of MB or CB), comments (e.g. Ketones, cannula site change, temporary basal, hypoglycemia Tx, fasting procedure)

• Diabetes insipidus
• DKA