Complications & Management of Diabetes Flashcards
What are the 3 acute complications that can occur for a diabetic?
- Hypoglycaemia
- Hyperglycaemia
- Diabetic ketoacidosis (DKA)
What causes diabetic ketoacidosis (DKA) and what are its measurement levels in the blood?
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
What can trigger DKA?
- Undiagnosed diabetes
- Missed insulin dose
- Supply of insulin not meeting the demand
- Infection/illness
How is DKA presented (symptoms)?
- Polyuria
- Glucose + water + salt lost in the urine, leading to dehydration so patient drinks more water & more frequent toilet visits - Fruity breath
- Due to the acetone build up - Kussmaul breathing
- Rapid breathing, which releases CO2 to compensate for the acidic blood - Polydipsia
- Increased water intake - Anorexia
How is DKA managed?
- Rehydration with IV fluids (0.9% saline solution)
- Fixed rate of IV insulin
- Possible K+ supplement, as insulin promotes K+ uptake by cells so risk of hypokalaemia present
What should you avoid the patient undergoing when treating DKA?
Hypoglycaemia.
What is HHS, and who is it more common in?
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.
What is absent in HHS, that is present in DKA?
Absence of ketones in HHS as type 2 diabetics still have some insulin in their system.
How do you manage HHS?
- IV 0.9% saline solution to restore dehydration & normalise osmolality
- 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
What is the blood glucose reading of hypoglycaemia?
<4mmol/L
What can cause hypoglycaemia?
Large insulin levels, and sulphonylureas.
What is the treatment of hypoglycaemia?
- Long acting carb + sugary drink
2. Glucogel/IV glucose if patient is unconscious or unable to drink/swallow
What are the 3 microvascular complications in diabetics?
- Retinopathy - eyes
- Neuropathy - nerves
- Nephropathy - kidneys
What causes retinopathy?
Hyperglycaemia can damage the small blood vessels in the eyes, leading to vision loss.
What are the 4 types of retinopathy?
- Background/mild non-proliferative - no change in vision, small haemorrhages
- Pre-proliferative - increased bleeding, more widespread
- Proliferative - weak blood vessels form which bleed easily
- Diabetic maculopathy - no colour vision, decreased acuity
What does a fundoscopy show?
It shows any leakages of fats/proteins from vessels in the retina (appearing yellow on images)
What is the management of retinopathy?
- Tight glycemic control
- Laser eye surgery
- Growth factor inhibitors
- Hyperlipidaemia control
What causes nephropathy?
Caused by damage to the glomeruli in kidneys, leading to protein lost in the urine.
What happens during hyperfiltration of the kidneys (due to nephropathy)?
Hyperfiltration occurs due to increased capillary pressure, which then damages nephrons.
This makes the kidneys more leaky & proteins are lost in the urine.
How do you manage nephropathy?
- Tight glycemic control + blood pressure
- ACEi
- Low protein diet + lipid control
What causes neuropathy and what are some of its symptoms?
Nerve damage caused by hyperglycaemia.
Symptoms include: tingling, pain, numbness, ulcers can also occur
How can neuropathy be managed and screened?
- Annual foot reviews held
- Manage pain with gabapentin, or pregabalin
- Treating infections/refer for ulcers
What can untreated neuropathy lead to?
Amputations.
What are 3 macrovascular complications that can occur for a diebetic?
- IHD - ischaemic heart disease
- CVD - cardiovascular disease
- Peripheral vascular disease - poor circulation to the limbs
What is the main cause of macrovascular complications in diabetes and what can it lead to?
Atherosclerosis, which narrows blood vessels.
This can lead to increased BP, excess free fatty acids & insulin resistance.
How are macrovascular complications managed?
- Patient education
- Tight glycemic control
- Controlling other CV risk factors = smoking, weight, alcohol, BP
What causes NAFLD and how is it treated?
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.
Who is more at risk of developing NAFLD?
Type 2 diabetics.
