2. Diagnosis and management of diabetes

Question 1

What is persistent hyperglycaemia and how is it used to dx diabetes

Answer 1

What Persistent hyperglycaemia is defined as:
HbA1c of 48 mmol/mol (6.5%) or more.
Fasting plasma glucose level of 7.0 mmol/L or more.
Random plasma glucose of 11.1 mmol/L or more in the presence of symptoms or signs of diabetes.
If the person is symptomatic, a single abnormal HbA1c or fasting plasma glucose level can be used, although repeat testing is sensible to confirm the diagnosis.
If the person is asymptomatic, do not diagnose diabetes on the basis of a single abnormal HbA1c or plasma glucose result. Arrange repeat testing, preferably with the same test, to confirm the diagnosis. If the repeat test result is normal, arrange to monitor the person for the development of diabetes, the frequency depending on clinical judgement.

Question 2

Clinical signs of DKA

Answer 2

Typical clinical signs associated with DKA include:

Dehydration: tachycardia, hypotension, reduced skin turgor, dry mucous membranes
Kussmaul breathing: rapid, deep breathing
Pear drop/acetone odour to the breath
Cerebral oedema: may present with decreased consciousness

Question 3

How to dx DKA

Answer 3

BG >11
Ketones> 3
Acidosis, venous pH<7.3

Question 4

Mx of DKA

Answer 4

1 litre Sodium Chloride 0.9% over 1 hour within 30 minutes of admission
Insulin IV 6 units/hour within 30 minutes of admission