Chemical Pathology - Hyperglycaemia Flashcards
What are some generic causese of hyperglycaemia?
- T1DM/T2DM
- Gestational diabetes
- Cushing’s
- Acromegaly
- Steroids
- Pancreatitis
- Post-stroke
- Post-MI
What are some symptoms of diabetes mellitus?
- Polydipsia
- Polyuria
- Blurred vision
- Unexplained weight loss
- Recurrent infections
- Tiredness
How is diabetes mellitus diagnosed?
IF Sx then one of below:
- HbA1c >48mmol/mol
- Fasting glucose >7mmol/L
- Random glucose >11.1mmol/L
- OGTT >11.1mmol/L (2-hr)
IF asymptomatic, then need repeat testing (with same test)
What are the prediabetic values for fasting glucose, HbA1c, random glucose/BM, OGTT?
Fasting glucose = 6.1-6.9
OGTT = 42-47
HbA1c = 42-47
Random BM/glucose = 7.8-11
What condition is more likely associated with DKA?
T1DM
What condition is more likely associated with HHS?
T2DM
What are three functions of insulin?
- Shuttles glucose into cells
- Inhibits glucagon
- Prevents glycolysis
What is the criteria for DKA?
- pH <7.3
- Plasma Glucose >11mM
- Blood Ketones >3mM (2+ in urine)
- Raised anion gap
Why are ketones produced in DKA?
Because there is no insulin
What are the symptoms of a DKA?
- Confusion
- Kussmaul breathing
- Abdominal pain
- Nausea
- Vomiting
What are some precipitants to DKA?
- Infection
- Surgery
- Missed insulin doses
- Trauma
What is the Mx for DKA?
- A-E approach (call for senior help early)
- Fluids
- 0.9% saline - SBP<90 = 500ml in 15 mins
- SBP>90 = 1L over 1hr - Insulin
- Started AFTER fluids
- Ensure K+ NOT <3.5
- 0.1u/kg/hr FIXED RATE REGIMEN - Early senior review +/- ITU involvement
- Monitor
- Monitor glucose + K+ hourly
- IF K+ low = give KCl
When is a DKA resolved?
- When ketones <0.6
- When pH >7.3
Why are no ketones made in HHS?
Because there’s insulin
What is the criteria for HHS?
- pH >7.3
- Osmolarity >320mOsm
- Blood glucose >30mM
- NO KETONES
