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MBBS 3: Internal Medicine > Complications of Diabetes > Flashcards

Complications of Diabetes Flashcards

1
Q

Clinical definition of Diabetic ketoacidosis?

A

Acute uncontrolled diabetes associated with ketoacidosis requiring insulin and intravenous fluids for treatment

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2
Q

Biochemical definition of diabetic keto acidosis?

A

Biochemical definition
-↑ serum ketones (ketonemia/ketonuria)
-low p H with low serum bicarbonate
-associated with ↑ anion gap (how do we calculate the gap?)(6-12 mEq/l)

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3
Q

Pathogenesis of DKA?

A

Absolute or relative def
↑ counter regulatory hormones ; glucagon, cortisol, growth hormone, epinephrine
Promotion of gluconeogenesis, glycogenolysis & lipolysis
↑ in hyperglycaemia & free fatty acid
↑ end metabolites –ketone bodies(ketones, keto-acids,β hydroxybutyrate)
Ketones induce vomiting & nausea & ketotic breath
Glycosuria leads to osmotic diuresis & ↑ osmolality
Severe dehydration

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4
Q

History of DKA?

A

compliance

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5
Q

Clinical exam findings IN DKA?

A
  1. source infections
  2. myocardial infarction
  3. DVT
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6
Q

Investigations in DKA?

A
  1. plasma glucose
  2. urine/serum ketones
  3. ABG
  4. U & E
  5. FBC
  6. osmolality
  7. Renal function
  8. urine/blood culture
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7
Q

Principles of treatment of DKA?

A
  1. fluid replacement
  2. insulin
  3. potassium replacement
  4. correction of acid base balance
  5. treat underlying recipitants
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8
Q

Fluid replacement in DKA?

A

N/S 0.9% or R/L:1-
1. 3L 1st hour
2.1L 2nd hour
3.1L 2hrs
4.1L every 4 hrs
- depending on the degree of dehydration

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9
Q

Insulin use in DKA?

A
  • Start 1 hr after rehydration
  • Ideally via an infusion pump /regular insulin at 0.1 U/Kg/hr
  • Optimal glucose drop @100/mg/hr in 4-5 hrs(not allow to drop below 200mg/dl)
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10
Q

Potassium replacement in DKA?

A
  • 20-40mEq/L if potassium is normal or low to each litre
  • 6mEq/L=no replacement
  • 4-6mEq/L=10mEq/hr
  • 3-4.5mEq/L=20mEq/L
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11
Q

What is hyperglycaemia hyperosmolar state?

A
  • Hyperglycaemia, hyperosmolar, dehydration without significant ketoacidosis
  • Common in type 2 DM & usually precipitated by infections
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12
Q

Clinical assessment of HHS?

A
  1. Glucose ~ 600mg/dl
  2. Osmolality ~ 320mOsm/kg(?calculation)(285-295mmol/kg)
  3. Serum Ph >7.30
  4. Bicarb> 15 mEq/l
  5. Altered consciousness
  6. Small or no ketonuria
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13
Q

HHS pathogenesis?

A
  1. increase in glucose causes osmotic shift out of cells causing intracellular dehydration
  2. no DKA due to basal insulin which is sufficient to stop ketogenesis but not to reduce glucose
    - usually old patient and first presentation of diabetes
    - can be precipitated by illness and dehydration
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14
Q

What is Hypoglycemia?

A

Blood glucose <40mg/dl(<2.5 mmol/l)
Usually have adrenergic and neuroglycopenic symptom

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15
Q

Management of hypoglycemia?

A
  1. 50 mls of 50% dextrose until glucose is within 5-10 mmo/l
  2. maintain with 10% dextrose to cover sulphonylurea effect(add 10 mls of 50 % dextrose to every 100 mls of 5% dextrose)
  3. allow to eat when fully awake
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16
Q

Microvascular complications of diabetes?

A

small vessel damage
1. retinopathy
2. nephropathy
3. neuropathy

17
Q

Macrovascular complications of diabetes?

A

medium/larger vessel damage
1. Myocardial infarction
2. stroke
3. PVD

18
Q

Macrovascular damage of medium to large cells?

A

Due to atherosclerosis there is increased risk of;
1. Myocardial infarction; usually tends to be silent
2. Cerebral vascular disease-stroke

19
Q

What is atherosclerosis?

A
  1. plaque with fibrous cap
  2. cap ruptures
  3. blood clot forms around the rupture, blocking the artery
20
Q

Retinopathy in diabetes?

A
  1. Pre-proliferative and proliferative retinopathy(see slides)
  2. Glaucoma
  3. cataract
21
Q

Progression of diabetic nephropathy?

A
  1. Control HPT & proteinuria with ACE inhibitors
  2. Tight glycaemic control
  3. Lipid lowering agents
  4. Consider SGLT2 inhibitors
  5. CKD stage 5
    - Consider dialysis
22
Q

Motor neuropathy?

A
  • muscle weakness > foot drop
  • muscle imbalance > deformities
23
Q

Sensory neuropathy?

A
  • loss of feeling > loss of protective sensation, ulcers
  • loss of proprioception > poo balance
24
Q

Autonomic neuropathy?

A
  • loss of sweat > dry cracked skin, ulcers
  • changes in blood flow > Charcot arthropathy
25
Q

Diabetic foot?

A

range of complictions:
1. neuropathy
2. peripheral vascular disease
3. ulcers
4. defromities e.g. Charcot foot, toe clawing, high arched foot
5. infection e.g. cellulitis, osteomyelitis

MBBS 3: Internal Medicine (72 decks)

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