Acute Complications of T1DM

Question 1

What can happen at absolute insulin deficiency?

Answer 1

DKA

Question 2

What can happen at a relative insulin deficiency?

Answer 2

Hyperosmolar Hyperglycaemia State

Question 3

What can happen at relative insulin excess?

Answer 3

Hypoglycaemia

Question 4

Name 2 causes of DKA

Answer 4

Hypergylcaemia+dehydration

Acidosis

Question 5

What is the Hyperosmolar Hyperglycaemic State (HHS)

Answer 5

Relative insulin deficiency

Enough insulin to prevent fat breaking down but not enough insulin to prevent the rising glucose

Question 6

Describe the pathophysiology of diabetic ketoacidosis

Answer 6

Hypeglycaemia
-Due to insulin deficiency

Glucose leaks into urine

• Glycosuria
• Loss of electrolytes
• Leads to dehydration

Loss of fluid can lead to hypovolumic shock

Increased lipolysis

• Increases FFA thus ketones
• High ketone levels causes acidosis by dissociating into H+ and anions

Question 7

Physiological compensation of acidosis

Answer 7

Increased buffering
-H+/K+ pump

Respiratory compensation
-Hyperventilation

Renal excretion of H+
-Slow

Renal loss of Na+ and K+

Question 8

Diabetic ketoacidosis - Precipitating factors

Answer 8

Infections

Erroneous/missed insulin

MI

Previously undiagnosed Type T1DM

Drugs that increase glucose [e.g steroids]

Question 9

Signs and symptoms from someone who has ketoacidosis caused by hypeglycaemia + dehydration

Answer 9

symptoms

• thirst
• polyuria
• weakness
• drowsiness and confusion

signs

• dry mouth
• postural/supine hypotension

Question 10

Signs and symptoms from someone who has ketoacidosis caused by acidosis

Answer 10

symptoms

• nausea
• vomitting

signs

• facial flush
• hyperventilation
• smell of ketone on breath
• ketonuria

Question 11

Diabetic ketoacidosis – clinical features

Answer 11

• Usually young pts
• Relative/absolute insulin deficiency
• Normal/low sodium

blood glucose(<40mmol/l)

• Low bicarbonate
• High serum ketones

Question 12

Diabetic ketoacidosis – Management

Answer 12

Confirm diagnosis and check for precipitating causes

Rehydrate + monitor fluid balance

Lower glucose w insulin

monitor electrolytes

prevent clots

Assess GCS

Risk of aspiration?

Question 13

Hyperosmolar Hyperglycaemic State (HHS)

CLINICAL FEATURES

Answer 13

usually older pts

High sodium

High glucose

No ketones

Corrected by correcting dehydration

Question 14

HHS - Management

Answer 14

Need to replace fluid but cautiously
-body is weaker so the fluid can go to the lungs and cause oedema
Can cause water shifts in the brain and cause brain damage

Question 15

How would you treat someone in a hypoglycaemic coma?

Answer 15

im or iv Glucagon 1mg

iv dextrose 25g (150ml 10% glucose)

Question 16

what is the difference between DKA and HSS

Answer 16

absence of ketones in HSS

normal bicarb in HSS

Question 17

Hypoglycaemia is defined as BG below

Answer 17

below 4 mmol/l

Question 18

Causes of Hypoglycaemia

Answer 18

insulin overdose

sulfonylureas

Question 19

hormones with anti-insulin effects

Answer 19

glucagon
adrenaline
cortisol
GH

Question 20

Treatment for minor episodes of hypoglycaemia

Answer 20

Minor episodes
20g carbohydrate as sugary drink, fruit juice, glucose tablets, glucose gels followed by something ‘starchy’ to eat
Glucose gels

Question 21

Treatment for hypoglycaemic coma

Answer 21

im or iv Glucagon 1mg

iv dextrose 25g (150ml 10% glucose)