Luke Ashill

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Recognising DKA, and learning to supervise

A week on the endocrine system and diabetic ketoacidosis, followed by my introduction to becoming a practice supervisor for student nurses.

Luke Ashill
· 2 min read

This week combined two things I care about: clinical knowledge and supporting other learners.

The endocrine system and DKA

Our lead lecture and tutorial focused on the endocrine system, and in particular on diabetic ketoacidosis (DKA). DKA is a medical emergency and nurses are often the first to spot it.

The underlying problem is a lack of insulin. Without it, the body can't use glucose for energy, so it starts breaking down fat instead. That produces ketones, which make the blood acidic. High blood glucose also pulls fluid out through the kidneys, so patients become dehydrated very quickly.

What I'll take onto the ward:

  • Know the signs. Nausea and vomiting, abdominal pain, thirst and passing a lot of urine, drowsiness or confusion, and deep, rapid breathing. The breath can smell of pear drops.
  • Check, don't assume. A patient with diabetes who is unwell and vomiting needs their blood glucose and ketones checked. Normal-looking glucose doesn't always rule DKA out.
  • Escalate early. DKA is managed with careful fluid replacement, a fixed-rate insulin infusion and close monitoring of potassium, glucose and ketones. Spotting it early and escalating promptly makes a real difference.
  • Think about the cause. Infection, missed insulin and new-onset type 1 diabetes are common triggers. Education on sick-day rules is part of preventing the next admission.

Preparing to be a practice supervisor

Later in the week I attended an introductory session on becoming a practice supervisor for student nurses. Under the NMC standards for student supervision and assessment, every registered nurse can supervise students. Doing it well is a skill in its own right.

With my background in education, I'm particularly interested in how supervisors create the conditions for learning: setting clear expectations, giving honest and kind feedback, and making it safe for a student to say "I don't know". The best supervisors I've had did all three. I'd like to be that person for someone else in the near future.