Complications of diabetes

Question 1

Emergency complications (3)

Answer 1

DKA - diabetic ketoacidosis
HHS - hyperglycaemic hypersmolar syndrome
Lactic acidosis

Question 2

DKA - definition

Answer 2

When insulin is not injected, cells fail to receive enough glucose and they switch to fat breakdown instead.
This results in the accumulation of ketones due to increased tissue fatty acid metabolism and increased blood glucose levels

Question 3

DKA - cause

Answer 3

Infection
Newly diagnosed diabetes
Non adherence with insulin
Alcohol

Question 4

DKA - which type of diabetics most commonly get it?

Answer 4

Type 1 diabetics

Question 5

DKA - classic history

Answer 5

2 day Hx of nausea after a party where the patient consumed lots of alcohol.
Pt is now not eating and therefore decided to reduce his insulin intake

Question 6

DKA - clinical features

Answer 6

Vomiting 
Abdominal pain
Kussmal breathing 
Pear drop smelling breath 
Drowsiness
Thirst
Polyuria
Dehydration

Question 7

DKA - investigations

Answer 7

Urinalysis: ++ketones, ++glucose
ABG: metabolic acidosis
Increased K+
Increased creatinine

Question 8

DKA - management

Answer 8

Replace fluid loss - NaCl
IV insulin
Prophylactic LMWH

Question 9

HHS - definition

Answer 9

Hypovolaemia + hyperglycaemia + hypersmolar (increased osmolality)

Question 10

HHS - cause

Answer 10

Steroids
Thiazides
Sepsis

Question 11

HHS - which type of diabetics most commonly get it ?

Answer 11

Type 2 diabetics

Question 12

HHS - clinical features

Answer 12

Nausea 
Thirst 
Polyuria 
Dry skin 
Drowsiness

Question 13

HHS - investigations

Answer 13

Urinalysis: + glucose, no ketones

Significant increase in osmolality (i.e. significant dehydration)

Question 14

HHS - management

Answer 14

Fluids
Insulin - in some patients
Sodium
LMWH

Question 15

Lactic acidosis - definition

Answer 15

Build up of lactate in the body due to anaerobic metabolism of glucose
It causes metabolic acidosis

Question 16

Lactic acidosis - clinical features

Answer 16

Hyperventilation

Mental confusion

Question 17

Lactic acidosis - investigations

Answer 17

Measure lactate level

Question 18

What is the normal lactate level?

Answer 18

O.6-1.2

Question 19

Lactic acidosis - management

Answer 19

Treat the underlying condition with fluids and antibiotics

Question 20

Alcohol induced ketoacidosis - definition

Answer 20

Metabolic complication of alcohol use and starvation

Question 21

Alcohol induced ketoacidosis - clinical features

Answer 21

Recurrent vomiting
Abdominal pain
Difficult to rouse

Question 22

Alcohol induced ketoacidosis - investigations

Answer 22

Increased ketones
Increased lactate
Decreased bicarbonate

Question 23

Alcohol induced ketoacidosis - management

Answer 23

High dose vitamins

IV fluids

Question 24

Microvascular complications of diabetes - risk factors

Answer 24

Increased duration of diabetes
Poor glycemic control 
Smoking
Alcohol
Mechanical injury

Question 25

Microvascular complications of diabetes - which type of diabetics are most likely to get this?

Answer 25

Type 1

Question 26

Microvascular complications of diabetes (4)

Answer 26

Feet problems Neuropathy Nephropathy Retinopathy

Question 27

Peripheral neuropathy - definition

Answer 27

Develops when the body's extremities are damaged

Question 28

Peripheral neuropathy - clinical features

Answer 28

``` Numbness Loss of sensation Tingling and burning (paraesthesia) Sharp pain Loss of balance ```

Question 29

Peripheral neuropathy - management

Answer 29

If localised: capsaicin cream | If generalised: amitryptiline, gabapentin

Question 30

Peripheral neuropathy - complications

Answer 30

Charcot's foot | Foot ulcer

Question 31

Autonomic neuropathy - definition

Answer 31

Affects nerves regulating the heart rate and blood pressure

Question 32

Autonomic neuropathy - clinical features

Answer 32

Changes in bowel habit, gastroparesis, change in heart rate and blood pressure

Question 33

FOcal neuropathy - definition

Answer 33

Affects a single nerve (mainly in wrist, thigh, foot)

Question 34

Diabetic foot ulcer pathogenesis

Answer 34

When NS is damaged, there is no sweating in the feet Feet become dry and cracked Infection can enter through the cracks

Question 35

Charcot's foot - pathogenesis

Answer 35

Injury to the numb foot results in gross abnormality as the patient has no awareness to the foot damage

Question 36

Nephropathy - definition

Answer 36

Caused by damage to the capillaries in the kidney's glomeruli

Question 37

Nephropathy - commonly affected areas

Answer 37

Peripheries | - hands and feet

Question 38

Nephropathy - clinical features

Answer 38

Discomfort in the lower legs Rapid weight loss Loss of sensation in the extremities of the limbs

Question 39

Nephropathy - investigations

Answer 39

Urinary albumin creatinine ratio

Question 40

Nephropathy - management

Answer 40

ACE inhibitor | ARB

Question 41

Retinopathy - definition

Answer 41

Disease of the retina which results in impaired vision or loss of vision

Question 42

Retinopathy - eye features

Answer 42

Blot haemorrhages Hard exudates Cotton wool spots Changes around the macula

Question 43

Retinopathy - management

Answer 43

Laser Vitrectomy Anti VEGF injections