High-Yield PSA Topic 1: Hypoglycaemia
Hypoglycaemia generally means: Blood glucose <4 mmol/L Common causes include:
Excess insulin
Missed meals
Increased exercise
Alcohol
Acute illness
Typical PSA Scenario
A patient with Type 1 diabetes becomes sweaty, shaky and confused. Glucose = 2.9 mmol/L. What is the most appropriate treatment?
If Conscious
Give rapid-acting carbohydrate:
Glucose tablets
Glucose gel
Sugary drink
Followed by:
Examples:
If Unconscious
Do NOT administer oral glucose. Use:
PSA Trap
Candidates often treat the glucose level but forget to continue insulin afterwards. Once recovered, ongoing insulin therapy remains essential in Type I diabetes.
High-Yield PSA Topic 2: Diabetic Ketoacidosis (DKA)
DKA = Hyperglycaemia + Ketones + Acidosis. Common symptoms:
Polyuria
Polydipsia
Abdominal pain
Vomiting
Dehydration
Reduced consciousness
Typical PSA Findings
Blood glucose - Elevated
Blood ketones - Elevated
pH - Low
Bicarbonate - Low
What Does the PSA Want You to Do?
Recognise DKA quickly. Management generally includes:
IV fluids
Fixed-rate insulin infusion
Potassium replacement where needed
Close monitoring
PSA Trap
The question may present a patient who has:
Ketones
Acidosis
Near-normal glucose
Candidates focus only on glucose and miss DKA. Always assess:
Ketones
pH
Clinical presentation
not just glucose concentration!
High-Yield PSA Topic 3: Sick Day Rules
During illness:
Continue insulin
Increase glucose monitoring
Increase ketone monitoring
Maintain hydration
Seek urgent medical advice if ketones rise
PSA Trap
A patient with gastroenteritis stops all insulin because they are not eating. This is unsafe. The correct advice is usually:
✅ Continue insulin and monitor closely
❌ Stop all insulin
High-Yield PSA Topic 4: Insulin Prescribing Errors
PSA questions frequently test medication safety.
Error 1: Omitting Basal Insulin
Common examples:
Insulin glargine
Insulin degludec
Insulin detemir
Stopping basal insulin can precipitate DKA.
Error 2: Wrong Insulin Product
Candidates are expected to recognise that insulin brands are not automatically interchangeable. Examples include:
NovoRapid®
NovoMix®
Humalog®
Humulin I®
These products have different formulations and actions.
Error 3: Unsafe Abbreviations
Never prescribe:
❌ 10U
This can be misread.
Prescribe:
✅ 10 units
High-Yield PSA Topic 5: Variable-Rate Intravenous Insulin Infusion (VRIII)
Hospital-based prescribing questions often involve:
Surgery
Fasting
Acute illness
A VRIII may be required.
PSA Trap
Candidates stop long-acting insulin when the variable-rate infusion is started. Generally:
✅ Continue the patient's usual basal insulin
This is a classic PSA safety point.
Top 10 PSA Type 1 Diabetes Exam Traps
1. Stopping all insulin
Most dangerous diabetes prescribing error.
2. Treating hypoglycaemia incorrectly
Giving oral treatment to an unconscious patient.
3. Missing DKA
Focusing solely on glucose.
4. Ignoring ketones
Ketones are frequently the key to the diagnosis.
5. Stopping basal insulin during VRIII
Very common assessment trap.
6. Prescribing insulin with "U"
Always write "units".
7. Choosing the wrong insulin preparation
Brand confusion remains a frequent source of error.
8. Assuming no eating means no insulin
Particularly dangerous in Type 1 diabetes.
9. Inadequate monitoring during illness
Patients should increase monitoring, not reduce it.
10. Delaying treatment of hypoglycaemia
Hypoglycaemia management should be immediate.
