Diabetes 2

Question 1

What are the symptoms of hypoglycaemia? When does it become symptomatic? How can it be treated?

Answer 1

shaking, sweating, anxiety, dizziness, hunger, fast heartbeat, impaired/blurred vision, weakness, fatigue, headache and irritability

becomes symptomatic when blood glucose is < 2.2mmol/L

conscious and able to swallow - glucose in liquid form (lucozade) or granulated sugar, glucose tablets, glucose gel
unconscious and unable to swallow - glucagon intramuscularly

Question 2

What is ketoacidosis? What causes it?

Answer 2

occur when there is severe insulin deficiency and the body cannot use glucose for energy so instead it uses fat and forms ketone bodies in the process

can be caused by
- undiagnosed diabetes, stress of intercurrent illness (infection or surgery) or interruption to insulin therapy

Question 3

What are symptoms of diabetic ketoacidosis?

Answer 3

Polyuria
Polydipsia - dehydration due to osmotic diuresis caused by high glucose circulation
Fatigue
Abdominal pain
Nausea, vomiting
Anorexia
Fruity breath from acetone production
Kussmaul breathing

Question 4

How can diabetic ketoacidosis be managed?

Answer 4

insulin
- iv infusion of soluble insulin = actrapid
- im is an alternative when infusion pump is unavailable or venous access is difficult (small children)

fluids
- need to expand extracellular fluid to restore circulation = iv saline

potassium-
- despite normal serum potassium, all DKA patients have whole body potassium depletion due to reduced uptake into cells
= may have hyperkalaemia

Question 5

What are complications associated with diabetes? How can they be treated?

Answer 5

macrovascular
- increased cardiovascular risks = atherosclerosis
= ACEi, ARB, lipid regulators, smoking cessation and diet

microvascular
- retinopathy
- nephropathy = ACEi, ARB
- neuropathy = amitriptyline, imipramine, duloxetine, pregabalin, gabapentin

sweating - antimuscarinic/anticholinergic
postural hypotension - fluids, fludrocortisone

diabetic foot - flucloxacillin, co-amoxiclav (if ulcer is also present)

osteomyelitis - clindamycin, co-amoxiclav (initially)

Question 6

What are the educational programs for diabetes?

Answer 6

DESMOND
- diabetes education and self management for ongoing and newly diagnosed DM
= T2DM

DAPHNE
- dose adjustment for normal eating
= T1DM

Question 7

What happens if diabetics take beta blockers?

Answer 7

beta blockers can mask the symptoms of hypoglycaemia
- tremors, anxiety, shaking

Question 8

How can a person be investigated for diabetic ketoacidosis?

Answer 8

Hyperglycaemia - > 20mmol/L
Plasma ketones
Urine stix testing - glycosuria and ketonuria
Arterial blood gases for metabolic acidosis
Urea and Creatinine levels - increased due to dehydration
Potassium levels - low in cells due to osmotic diuresis and insufficient insulin, high in serum
Bicarbonate levels - low in serum due to insulin deficiency