Diabetes Flashcards
Symptoms of DKA
Polyuria polydipsia weight loss weakness Nausea vomiting leg cramps blurred vision abdominal pain
Signs of DKA
Kussmaul breathing (deep and laboured breathing), dehydration Hypotension - postural or supine Cold extremities/peripheral cyanosis tachycardia smell of acetone hypothermia confusion, drowsiness, coma
How to differentiate between DKA and HONK
Different to DKA – severe hyperglycaemia = osmotic diuresis and lack of hydration
usually in old people with not enough water or complication of T2D
Causes osmotic diuresis and severe dehydration only (not ketone bodies or acidosis)
no nausea
no vomiting
no kussmaul breathing
Symptoms and signs of Hypoglycaemia
Causes from lack of eating sweating, tachycardia, dizziness, palpitation, Hunger Anxiety CNS confusion (remember back to EM - always check glucose in confused patients) Drowsiness Speech difficulty Inability to concentrate Incoordination Irritability and anger Nausea Tiredness Headache
Retinopathy of diabetes
Non proliferative = Cataract (sorbitol), Microaneursyms (Dots), Haemorrhages (Blots), Hard exudate, Soft/cotton wool infarcts
Proliferative = Neovascularisation, Retina sheet haemorrhages, Retinal detachment.
Nephropathy of diabetes
Nodular glomerulosclerosis
Pyelonephritis
Necrotising papilitis
Renal artery atherosclerosis
Neuropathy of diabetes
Focal demyelination due to microangiopathy and direct glycosylation
PNS - Sensory then motor. Bilateral, distal, pains and needles in glove and sock pattern. Progressive and irreversible
Visceral nerves
- CN = diplopia, bells palsy
- GIT - constipation or diarrhoea
- CNS - Postural hypotension
Dermatopathy of diabetes
Neuropathic ulcer (on pressure point, painless, hyperkeratosis around. Loss of sensation but blood flow not affected) Diabetic Xanthoma (Red, yellow, pruritic, painful) Gangree (most common)
Diagnosis of T2D
FBG >/= 7 on two separate occasions
2 hour postprandial >11 on OGTT on two separate occasions
HbA1c >6.5% on 2 separate occasion
Or symptomatic pt with 1 raised blood level.
Classic symptoms of uncontrolled diabetes
Polyuria (every 1hr or so) Polydipsia Loss of wt if type 1 Tiredness and fatigue Characteristic breath Propensity for infections sep, of the skin and genitals
Ix to order to screen for diabetes
After AUSRISK
FBG or RBG
Then HbA1c as not funded.
Mx of a new diabetic
Advise road traffic authority Assess modifiable risk factors Assess CVD risk PAID tool Refer to diabetes teams Medication - Type 1 - Insulin. Basal bolus and Rapid if needed - Type 2 - Lifestyle, Metformin or sulphonylureas or Alpha glucosidase inhibitors , or glitazones, or meglitinides.
Mx of diabetic
Achieve strict glycemic control 30min/d. Referral to ophthalmologist Goals of management - No smoking - Alcohol - = 2 drinks per day Chronic disease plan
Examination of a diabetic patient
GI - Gait - ask the patient to walk
Overweight, acanthosis nigricans, hemochromatosis coloration. look behind neck
Dehydration. recent wt loss, pigmentation (haemochromatosis)
Vital signs: No change in O2 saturation, RR HR and BP if presenting alone. Increased BSL and increased BMI expected.
Diabetic foot exam
Inspection:
Structure – bunions, hallux valgus, pes-cavus, pes plantus
Vascular – pedal oedema, atrophic shiny skin, hair loss
Infection – check legs and feet for ulcers, including between toes, boils, Cellulitis
Neurological – Charcot’s joint, wasting of quadriceps
Other – necrobiosis lipoidica diabeticorum and diabetic dermopathy.
Top to bottom - Thigh wasting, charcot joint, Loss of hair, thin atrophic, shiny skin, pedal oedema, dry skin, diabetic dermopathy (pigment over skin), skin discolouration, venous stasis, fungal nail, thickening nail, boils, cellulitis, ulcer, hallaux values, bunions, calluses, Pes cavus/Pes planus.
Palpation: Feel warmth of legs, peripheral pulses and CRT.
Light touch at 10 points on foot, sharp touch on dorsum of foot, vibration at distal hallux, proprioception.
Perform a survey of muscle tone, power and bulk.
Perform reflexes at knee, ankle and plantar surface of foot.
For completion
Face - Fundiscopy for proliferative and non proliferative diabetic retinopathy or hypertension retinopathy. cataracts
Mouth - signs of infection and fetor, dehydration
CVS - Cardiomyopathy, IHD
Resp - signs of infection
GIT - injection site and fat atrophy.
Neuro - peripheral and central neuropathy
Q to ask a known diabetic
- Age of Dx
- Insulin required from the start?
- Presentation that lead to Dx
- what previous and current tx r u on?
- Diet?
- Self monitoring? ranges?
- Previous hypos? sweating, confusion, malaise or LOC?
- Does pt know what to do if hypo or hyper happens?
- Hx of DKA and hospital admission?
- Cx of diabetes e.g. eyes, nerves BV, kidneys
- Any regular testing for Cx
- How is the pt and their family coping
- Ability to work?
