Essential safety checks to prevent diabetes related harms arising in ED and acute admissions units
Acronym for remembering the 5 essential checks
SNACK and TICKLE (Think Insulin, Check Ketones, Listen, Examine feet)
SNACK
Hypoglycaemia
A carbohydrate snack should be provided for insulin and SU treated patients to prevent hypo in the department.
Think Insulin
DKA in Type 1 DM
Insulin – A TIME CRITICAL MEDICINE – must be given on time to prevent DKA and subsequent doses prescribed particularly basal insulin.
If own insulin unavailable – link for substitution pdf >
Check Ketones
DKA and SGLT-2i
Check ketones in all on SGLT2 inhibitors and withhold if unwell.
Listen
Patient voice
People with diabetes and carers can provide key information, including current insulin regimen, time of last injection and recent food intake.
If capable, it is safer to allow them to SAMI (Self-Administer and Manage Insulin) while in the department.
Examine feet
Infection/Neuropathy
Foot infection – a common cause of systemic sepsis – should not be missed
Loss sensation is a high risk for pressure ulceration
The Ipswich Touch Test is a simple 30 sec. screening tool: Click here to see video >