Blood glucose disturbance

Question 1

What are the diagnostic criteria for DKA?

Answer 1

pH <7.3, Ketones ++ or >3, glucose >11

Question 2

When is potassium given in DKA?

Answer 2

If K+ <5.5. Add 40mmol to the 2nd bag of fluids.

Question 3

What are the Sx of hypoglycaemia?

Answer 3

Hungry, tired, weak, pale, sweaty, tremor, blurred vision, slurred speech, tachycardia, confused, seizures

Question 4

What things do you need to ask about in a hypoglycaemia Hx?

Answer 4

All the Sx, eating, exercise, previous episodes, medication compliance, weight loss, alcohol, signs infection

Question 5

What is the Mx of a patient with a GCS of 11 and a glucose of 3.1. The patient is believed to have taken an OD of insulin

Answer 5

IV glucose STAT.
1mg glucagon to reverse insulin - IM/SC/IV.
Then start IV 10% dextrose, 1L over 4-8h

Question 6

What would be the management plan for a patient who is getting repeated hypos?

Answer 6

Refer to diabetic team as may need to lower insulin/hypoglycaemics dose

Question 7

What is the Mx of a patient with a glucose of 3.5 who is having a conversation with you?

Answer 7

120ml lucozade or single dose of glucose gel. Maintain glucose >5. If remain persistently hypo –> 1L IV 10% glucose over 6-8h

Question 8

What is HHS?

Answer 8

Severe uncorrected hyperglycaemia in the presence of residual insulin production –> dehydration. But not ketones

Question 9

What are the precipitants of HHS?

Answer 9

Unknown Hx diabetes, CVA, MI, poor med compliance, infection, high sugar diet

Question 10

How is HHS diagnosed?

Answer 10

Glucose very high! Often >50.
U+E = severe dehydration (raised urea, albumin)
Plasma osmolality >350mosm/kg