Clinical demonstration : diabetes, coma and complications

Question 1

What are the acute complications of diabetes?

Answer 1

Hypoglycaemia

Diabetic coma

Question 2

What are the chronic complications of diabetes?

Answer 2

Microvascular - neuropathy, retinopathy, nephropathy

Macrovascular - IHD, CVA, PVD

Question 3

Describe acute hypoglycaemia?

Answer 3

Low glucose in brain and muscles
BRAIN - double vision, slurred speech, lack of concentration, confusion, behaviour change, epilepsy
MUSCLES - shaking, tremble, sweat, pins and needles, hunger, headache, palpitations

Question 4

What is the normal response to low glucose in the blood?

And what happens to this mechanism when hypoglycaemic?

Answer 4

Brain:
-GH - decreased peripheral glucose uptake
- ACTH - adrenal:
– cortisol - decreased peripheral glucose uptake
– adrenaline - liver - increase production of glucose (when combined with glucagon acting on the liver, released from the pancreas)
When hypoglycaemic, the pancreas doesnt release and glucagon and so the liver doesnt make more glucose

Question 5

What are the causes of hypoglycaemia?

Answer 5

missed meals, alcohol, unaware, too much insulin

Question 6

What is the treatment for hypoglycaemia?

Answer 6

IF PT CONSCIOUS - oral glucose and long lasting carbs
IF PT DROWSY - hypostop
IF PT UNCONSCIOUS - s/c glucagon, IV 50% dextrose

Question 7

What are the 2 types of diabetic coma?

Answer 7

Diabetic ketoacidosis (DKA) 25% mortality
Hyperosmolar nn- ketotis hyperglycaemia (HONK)

Question 8

What are the signs and symptoms for DKA?

Answer 8

SIGNS:
tachycardia, dehydration, hyperfentilation, ketotic breath, hypotension, coma
SYMPTOMS:
vomiting, thirst, polyurea, abdominal pain, weak, lethargy

Question 9

What 3 things do you need to know to diagnose DKA?

Answer 9

blood sugar >15
urine ketones >2+
blood pH

Question 10

What are the causes of DKA?

Answer 10

inadequate insulin, surgery, infection, pregnancy

Question 11

How does DKA occur?

Answer 11

Insulin lack - breakdown fat- increased ketogenesis - ketoacidosis
Decreased glucose uptake - increased hepatic output - hyper glycaemia - osmotic diuresis (low K+, Na+, Cl-) - dehydration - hypotension

Question 12

What is the treatment for DKA?

Answer 12

IV insulin if insulin deficiency
IV dextrose if starving
IV saline if dehydrated
Treat underlying disorder

Question 13

What is HONK?

Answer 13

commonest coma in type 2 diabetes
similar presentation and treatment to DKA
NO KETONES AND NO ACIDOSIS

Question 14

What 4 things do you need to know to diagnose HONK?

Answer 14

blood glucose >30
pH blood >7.2
urine ketone 350

Question 15

What is the treatment for HONK?

Answer 15

Heparin if clotting risk
IV insulin if insulin deficiency
IV dextrose if starving
IV saline if dehydrated
Treat underlying disorder

Question 16

Describe chronic hypoglycaemia?

Answer 16

Microvascular and macrovascula

Question 17

Describe microvascular disease?

Answer 17

HbA1c dependant, not in IGT, not in type 2,

Question 18

Describe macrovascular disease?

Answer 18

HbA1c independant, present in IGT, metformin decreases risk, F>M
Factors affecting it: microalbuminurea, BP, insulin concentration, weight, cholesterol