Adult Hyperglycaemia

Question 1

Patients on SGLT2 Inhibitors may present with what?

Answer 1

• Euglycaemic ketoacidosis

Question 2

What is the suffix for SGLT2 inhibitors

Answer 2

• Flozins

Question 3

What is mild to moderate hyperglycaemia/Ketosis

Answer 3

• BGL 11 - 27.8 AND/OR Ketones 0.6 - 3mmol/L
  AND
• Does not meet criteria for severe hyperglycaemia

Question 4

What needs to be excluded in mild to moderate hyperglycaemia/ketosis

Answer 4

Other causes
- ACS
- Infection/sepsis

Question 5

What is Severe Hyperglycaemia/ketosis?

Answer 5

• BGL >27.8 AND/OR Ketones >3mmol/L
• Less than adequate perfusion
• Clinical features of DKA
• Clinical Features of HHS

Question 6

What are some clinical features of DKA

Answer 6

• Kussmauls breathing
• Altered conscious state
• Ketotic breath
• Dehydration
• Profound thirst
• Nausea/vomiting
• Abdominal pain

Question 7

What are some clinical features of HHS

Answer 7

• Altered conscious state
• Dehydration

Question 8

What is the Mx for Severe hyperglycaemia/ketosis

Answer 8

• Request MICA support
• Cardiac monitoring and ECG
• Normal Saline 1000 - 2000 mL IV
  + Administer over 1hour if BP > 90mmHg
  + Consult clinician if inadequate response

Question 9

What is cardiac monitoring required in Hyperglycaemic patients

Answer 9

• Hyperosmolarity forces potassium out of cells leading to hyperkalemia
• High sugar levels can also lead to kidney disfunction leading to reduced filtration of potassium

Question 10

When should reduced fluid be provided in Hyperglycaemia?

Answer 10

• Hisotry of cardiac failure
• Chronic renal failure
• Elderly

Question 11

What is the pathophysiology of DKA

Answer 11

1. Type 1 diabetics
2. Insulin deficieny
3. Stress, infection of insufficient inulin intake
4. Increase in Counterregulatory Hormones (Glucagon, Cortisol, Catecholamines, Growth hormone)
5. Increases lipolysis (Instead of glucose being used)
6. FFA end up in the liver
7. Converted to Ketones (Acetate)
8. Increased glycogenolysis leading to increased amounts of sugar in the body
9. High levels of sugar feed into the kidneys and draw water and electrolytes (Osmotic diuresis
10. Leads to dehydration
11. Renal failure
12. Shock
13. Coma
14. Death

Question 12

What is the pathophysiology of HHS?

Answer 12

• Type 2
• Insulin still present
• Insulin not being utilised properly but inhibiting lipolysis
• Cells not uptaking sugar
• Increase glycogenolysis to increase sugar levels
• High BSL
• leads to osmotic diuresis
• leads to dehydration and hypovolaemia