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PY6030 > Complications & Management of Diabetes > Flashcards

Complications & Management of Diabetes Flashcards

1
Q

What are the 3 acute complications that can occur for a diabetic?

A
  1. Hypoglycaemia
  2. Hyperglycaemia
  3. Diabetic ketoacidosis (DKA)
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2
Q

What causes diabetic ketoacidosis (DKA) and what are its measurement levels in the blood?

A

It is due to lack of insulin (hyperglycaemia). This metabolises fats (lipolysis) as glucose cannot be up-taken by cells due to the lack of insulin, and so free fatty acids are released. These are then converted to ketones, which can make the blood more acidic.

> 3mmol/L of ketones + hyperglycaemia = DKA
<15mmol/L of bicarbonate + acidosis = DKA

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3
Q

What can trigger DKA?

A
  1. Undiagnosed diabetes
  2. Missed insulin dose
  3. Supply of insulin not meeting the demand
  4. Infection/illness
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4
Q

How is DKA presented (symptoms)?

A
  1. Polyuria
    - Glucose + water + salt lost in the urine, leading to dehydration so patient drinks more water & more frequent toilet visits
  2. Fruity breath
    - Due to the acetone build up
  3. Kussmaul breathing
    - Rapid breathing, which releases CO2 to compensate for the acidic blood
  4. Polydipsia
    - Increased water intake
  5. Anorexia
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5
Q

How is DKA managed?

A
  1. Rehydration with IV fluids (0.9% saline solution)
  2. Fixed rate of IV insulin
  3. Possible K+ supplement, as insulin promotes K+ uptake by cells so risk of hypokalaemia present
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6
Q

What should you avoid the patient undergoing when treating DKA?

A

Hypoglycaemia.

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7
Q

What is HHS, and who is it more common in?

A

HHS: Hyperosmolar hyperglycaemic state
It is a blood glucose reading of >30mmol/L
This leads to more water lost in the urine, causing blood to become more concentrated with glucose & salts
It is more common in type 2 diabetics.

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8
Q

What is absent in HHS, that is present in DKA?

A

Absence of ketones in HHS as type 2 diabetics still have some insulin in their system.

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9
Q

How do you manage HHS?

A
  1. IV 0.9% saline solution to restore dehydration & normalise osmolality
  2. K+ replacement

NO INSULIN GIVEN - unless sugar levels do not drop after treatment or ketones are present
Fluids can also deplete Na+ so ensure levels do not fall <10mmol/L

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10
Q

What is the blood glucose reading of hypoglycaemia?

A

<4mmol/L

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11
Q

What can cause hypoglycaemia?

A

Large insulin levels, and sulphonylureas.

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12
Q

What is the treatment of hypoglycaemia?

A
  1. Long acting carb + sugary drink

2. Glucogel/IV glucose if patient is unconscious or unable to drink/swallow

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13
Q

What are the 3 microvascular complications in diabetics?

A
  1. Retinopathy - eyes
  2. Neuropathy - nerves
  3. Nephropathy - kidneys
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14
Q

What causes retinopathy?

A

Hyperglycaemia can damage the small blood vessels in the eyes, leading to vision loss.

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15
Q

What are the 4 types of retinopathy?

A
  1. Background/mild non-proliferative - no change in vision, small haemorrhages
  2. Pre-proliferative - increased bleeding, more widespread
  3. Proliferative - weak blood vessels form which bleed easily
  4. Diabetic maculopathy - no colour vision, decreased acuity
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16
Q

What does a fundoscopy show?

A

It shows any leakages of fats/proteins from vessels in the retina (appearing yellow on images)

17
Q

What is the management of retinopathy?

A
  1. Tight glycemic control
  2. Laser eye surgery
  3. Growth factor inhibitors
  4. Hyperlipidaemia control
18
Q

What causes nephropathy?

A

Caused by damage to the glomeruli in kidneys, leading to protein lost in the urine.

19
Q

What happens during hyperfiltration of the kidneys (due to nephropathy)?

A

Hyperfiltration occurs due to increased capillary pressure, which then damages nephrons.
This makes the kidneys more leaky & proteins are lost in the urine.

20
Q

How do you manage nephropathy?

A
  1. Tight glycemic control + blood pressure
  2. ACEi
  3. Low protein diet + lipid control
21
Q

What causes neuropathy and what are some of its symptoms?

A

Nerve damage caused by hyperglycaemia.

Symptoms include: tingling, pain, numbness, ulcers can also occur

22
Q

How can neuropathy be managed and screened?

A
  1. Annual foot reviews held
  2. Manage pain with gabapentin, or pregabalin
  3. Treating infections/refer for ulcers
23
Q

What can untreated neuropathy lead to?

A

Amputations.

24
Q

What are 3 macrovascular complications that can occur for a diebetic?

A
  1. IHD - ischaemic heart disease
  2. CVD - cardiovascular disease
  3. Peripheral vascular disease - poor circulation to the limbs
25
Q

What is the main cause of macrovascular complications in diabetes and what can it lead to?

A

Atherosclerosis, which narrows blood vessels.

This can lead to increased BP, excess free fatty acids & insulin resistance.

26
Q

How are macrovascular complications managed?

A
  1. Patient education
  2. Tight glycemic control
  3. Controlling other CV risk factors = smoking, weight, alcohol, BP
27
Q

What causes NAFLD and how is it treated?

A

NAFLD: Non-alcoholic fatty liver disease
It is due to high fat deposition in hepatocytes, which can lead to cirrhosis/liver cancer
Main treatment is to decrease weight/lipids, and control diabetes.

28
Q

Who is more at risk of developing NAFLD?

A

Type 2 diabetics.

PY6030 (23 decks)

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