Diabetes 2

Question 1

Describe the acute and long term complications of diabetes resulting from poor control

Answer 1

Acute - Diabetic ketoacidosis, Hypoglycaemia
Long term - Microvascular, Macrovascular

Question 2

Describe the pathology of diabetic ketoacidosis

Answer 2

1. Blood glucose levels rise, body breaks down fat releasing fatty acids, these are oxidised in the liver to ketone bodies.
2. Ketones are acidic, decreasing body pH -> diabetic ketoacidosis

Question 3

What are the causes of diabetic ketoacidosis?

Answer 3

• Omission of insulin
• insufficient insulin due to: infection, acute illness, trauma, emotional disturbances, drugs

Question 4

What are the symptoms of diabetic ketoacidosis?

Answer 4

Ketosis (elevated ketones in blood), excessive urination, thirst, vomiting, hyperventilation, tachycardia, confusion, weakness

Question 5

What is the treatment for diabetic ketoacidosis?

Answer 5

Insulin, fluids, K ions

Question 6

How do you avoid diabetic ketoacidosis?

Answer 6

Optimisation of insulin treatment, avoid insulin omission, concurrent illness: “sick day rules”

Question 7

Describe the sick day rules for avoiding diabetic ketoacidosis

Answer 7

• Continue to take insulin/tablets
• Test blood glucose at least 4x daily
• Test urine for ketones
• Drink plenty of fluids

Question 8

What is hypoglycaemia?

Answer 8

A blood glucose level below 4mmol/l with or without symptoms
(A complication of drug treatment NOT the disease)

Question 9

What are the causes of hypoglycaemia?

Answer 9

Too much insulin/tablets, missed/late meals, too little food, exercise, alcohol, weather

Question 10

What are the symptoms of hypoglycaemia?

Answer 10

• Early warning: hunger pangs, shaking, pale skin, sweating
• Cognitive dysfunction: mood changes, irrational behaviour, vagueness, uncoordinated movements

Question 11

What is the treatment for hypoglycaemia?

Answer 11

• Quick acting sugar (15-20g) - liquid preferred
  E.g. small glass of sugary drink, 4-6 dextrose tabs, soft sweets
• repeat after 5-10 mins if necessary, slow acting carbohydrate follow up (sandwich, Biscuits, cereal)
• if unconscious: glycogen Hypokit (glucagon 1mg) SC/IM/IV - 999 if no response

Question 12

What are the complications of frequent episodes hypoglycaemia?

Answer 12

• brain now considers low levels “normal”
• loss of awareness

Question 13

What are the types of microvascular complications of diabetes? (usually type 2)

Answer 13

Retinopathy, Nephropathy, Neuropathy

Question 14

What is Retinopathy?

Answer 14

Eye damage causing visual impairment/blindness, increases risk of cataracts and glaucoma

Question 15

What can diabetic neuropathy manifest as?

Answer 15

• Foot problems (numbness and neuropathic pain)
• Erectile dysfunction
• Bladder and bowel effects

Question 16

What are the risk factors for microvascular complications?

Answer 16

Hyperglycaemia, hypertension, aging, dyslipidaemia, smoking

Question 17

What are the long term macrovascular complications of diabetes?

Answer 17

More likely to suffer a heart attack, stroke, or heart failure irrespective of other factors

Question 18

What are the cardiovascular risk factors of diabetes?

Answer 18

Hyperglycaemia, hypertension, dyslipidaemia, smoking, microalbuminuria

Question 19

What biochemicals need to be monitored with diabetes?

Answer 19

Glucose, HbA1c (glycated Haemoglobin) and ketones

Question 20

What clinical monitoring needs to take place annually with diabetics?

Answer 20

Feet, eyes, renal, neurological, cardiovascular

Question 21

What is HbA1c and what is it proportional to?

Answer 21

HbA1c is the fraction of haemoglobin irreversibly bound to glucose and is proportional to the average level of glucose in the blood over a three month period (reflects glucose control over past three months)