Diabetes Flashcards
What is diabetic ketoacidosis?
An acute metabolic complication of diabetes characterised by hyperglycaemia, hyperketonemia and metabolic acidosis Diabetic Ketoacidosis (DKA) is a disordered metabolic state that usually occurs in the context of an absolute or relative insulin deficiency accompanied by an increase in the counter-regulatory hormones i.e. glucagon, adrenaline, cortisol and growth hormone
Specific Symptoms of DKA
Polydipsia
Polyuria
Kussmaul breathing
Other Symptoms: Nausea Vomitting Abdominal pain Poor appetite Tiredness Weakness Coma Cerebral Oedema Thrombotic Events Death
Three characteristics of DKA?
Hyperglycaemia
Hyperketonemia
Metabolic acidosis
Counter regulatory hormones that increase glucose production?
Glucagon
Cortisol
Catecholamines
Most common causes of DKA?
Not taking medication
Infection
Alcohol abuse
What does adrenaline do?
Stimulates glucagon release and lipolysis, increasing fatty acids but not ketones
Cortisol and gluoneogenesis?
Cortisol stimulates gluconeogenesis in the liver from amino acids, lactate, glycerol and propionate
Which hormone stimulates gluconeogenesis from amino acids, lactate, glycerol and propionate?
Cortisol
Growth hormone, glucose and lipolysis?
GH reduces hepatic uptake of glucose
GH stimulates lipolysis
pH and bicarbonate levels in DKA?
pH <15mmol/l
Why would you check blood gases in DKA?
To look at H+ and bicarbonate levels
Why would you check urea and electrolytes in DKA?
Indication of dehydration (urea, creatinine)
Individual ion and anion levels
Indication of hyperkalaemia
What would urine show in diabetic ketoacidosis?
Low pH (<7.30)
Glucose
Ketones
What is a common trigger for illness in a person with diabetes?
Urinary infection
Three main ketone bodies?
Acetone
Acetoacetate
Beta hydroxybutyrate
(all of these, especially beta hydroxybutyrate will make the patient feel v. sick. This is important to realise as if the patient is sick then this will make their fluid and electrolyte loss even worse)
Why is alcohol of significance in DKA?
It gives the person the fruity breath smell
What will blood gases show in patient with Kussmaul breathing?
Low partial pressure of CO2
Low bicarbonate
High oxygen saturation (99-100% unless patient has pathologies that prevents this, e.g. COPD)
What would hyponatremia suggest in a patient with DKA?
That they have been vomitting
lose sodium when they vomit, also lose through urine due to osmotic diuresis caused by hyperglycemia
What causes dehydration in DKA?
Dehydration is caused by volume depletion from 2 main causes:
1) Renal loss due to the osmotic diuresis caused by hyperglycemia
2) Fluid loss from vomitting caused by the ketosis
Specific DKA symptoms
Polyuria
Polydipsia
Kussmaul breathing
General symptoms of DKA
Vomitting Nausea Abdominal Pain Weakness Tiredness Coma Cerebral oedema Thrombotic events
Immediate effects of low insulin
Hyperglycemia
Increased hepatic gluconeogenesis
Increased levels of chatecholamines
Best way to treat CVD risk in type 2 diabetes?
Statins/anti-hypertensives
(insulin resistance -> macrovascular complications -> CVD risk etc -> statins/ anti-hypertensives )
(beta cell dysfunction -> hyperglycemia -> MICROvascular complications -> treat with intensive glucose control)
What is diabetes mellitus?
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.