Diabetes Flashcards
What is diabetes ketoacidosis?
When there is a severe lack of insulin in the the body so the body is unable to use glucose for energy. Thus as a result the body uses fats for energy which release ketones.
Who is more at risk of DKA?
People with type 1 diabetes
What are the signs and symptoms of DKA?
- high blood sugar levels
- being very thirsty
- needing to pee more often
- feeling tired and sleepy
- confusion
- blurred vision
- stomach pain
- feeling or being sick
- sweet or fruity-smelling breath (like nail polish remover or pear drop sweets)
- passing out.
What are the signs and symptoms of Type 1 diabetes?
The 4Ts which are the four most common signs:
Toilet - Going to the toilet a lot, bed wetting by a previously dry child or heavier nappies in babies.
Thirsty - Being really thirsty and not being able to quench the thirst.
Tired - Feeling more tired than usual.
Thinner - Losing weight or looking thinner than usual.
What are the treatment for DKA?
- Being given insulin through a vein
- Being given fluids through a vein to rehydrate your body
- Being given nutrients through a vein to replace any you’ve lost
What can DKA lead to?
DKA is a medical emergency because it leads to dehydration and electrolyte imbalances. The mechanisms responsible for fluid depletion in DKA include osmotic diuresis due to hyperglycaemia, vomiting, and inability to take in fluid owing to a diminished level of consciousness. Electrolyte shifts and depletion are in part related to the osmotic diuresis.
What are the risks with SEVERE HYPOglycaemia?
- Convulsions
- Inability to swallow
- Loss of consciousness
- Coma.
What is the finger-prick blood glucose levels that indicates significant HYPERglycaemia?
finger-prick blood glucose level greater than 11 mmol/L
What are the clinical features of HYPERglycaemia?
Increased thirst and urinary frequency.
Weight loss.
Inability to tolerate fluids.
Persistent vomiting and/or diarrhoea.
Abdominal pain.
Visual disturbance.
Lethargy and/or confusion.
Fruity smell of acetone on the breath.
Acidotic breathing — deep sighing (Kussmaul) respiration.
Dehydration, which can be classified as:
-Mild — only just clinically detectable.
-Moderate — dry skin and mucus membranes, and reduced skin turgor.
-Severe — sunken eyes and prolonged capillary refill time.
Shock (resulting from severe dehydration). The person is severely ill with:
Tachycardia, poor peripheral perfusion, and (as a late sign) hypotension (indicating decreased cardiac output).
Lethargy, drowsiness, or decreased level of consciousness (indicating decreased cerebral perfusion).
Reduced urine output (indicating decreased renal perfusion
What are the precipitating factors of DKA?
- Infection (for example pneumonia or a urinary tract infection).
- Physiological stress (such as trauma or surgery).
- Non-adherence to insulin treatment regimen or intentional insulin omission in order to lose weight (diabulimia).
- Other medical conditions (such as hypothyroidism or pancreatitis).
- Drug treatment (such as corticosteroids, diuretics, and sympathomimetic drugs [for example salbutamol]).
Where are ketones made?
They are produced by the liver when there is a lack of glucose [starvation ketones] and as an alternative energy source when there is a relative insulin deficiency
How to test for DKA and what is considered a high ketone in the urine and blood
For an adult test for urine or blood ketones even if plasma glucose levels are near normal.
In a child or young person with suspected DKA, test for blood ketones. If this is not possible, arrange immediate admission to a hospital with acute paediatric facilities.
Ketones are high if above 2+ in the urine or above 3 mmol/L in the blood.
A blood test will show ketone levels in real time but a urine test will show what they were a few hours ago.
What are the anti-diabetic medications to stop when someone is sick?
- Metformin – dehydration can make it more likely that you will develop a serious side effect
called lactic acidosis - Sulfonylureas – if you are unable to eat or drink, it will be more likely that you develop low
blood glucose (hypos)
Examples: names ending with ‘ide’ such as gliclazide, glibencamide, glipizide
If you are eating and drinking normally and blood sugars are high continue to
take Sulfonylureas - GLP-1 analogues –dehydration can make it more likely that you will develop a serious side
effect.
Examples: names ending with ‘tide’ such as exenatide, dulaglutide, liraglutide,
lixisenatide and semaglutide - SGLT2 inhibitors – dehydration can make it more likely that you will develop a serious side
effect called ketoacidosis.
Examples: names ending with ‘flozin’ such as canagliflozin, dapagliflozin,
empagliflozin and ertugliflozin
Restart when patient is well again (normally after 24 to 48 hours of eating and drinking normally). When
patient restart medicines, they should take them as normal
What are the background Insulin (given once or twice daily)?
Insulatard Humulin I Insuman Basal Lantus Abasaglar Semglee Levemir
What are the twice daily Mixed Insulin?
Novomix 30
Humalog Mix 25
Humalog Mix 50
Humulin M
