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Phase 2 - General Medicine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is HONK?

A

Hyperosmolar Non-Ketogenic hyperglycaemia
Like DKA but in non-insulin dependent diabetics.
Has a longer onset of dehydration

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2
Q

What causes HONK?

A

Normally set off by an illness (UTI, pneumonia)

Seen in older or non-diagnosed diabetics

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3
Q

What is the level for hypoglycaemia?

A

<3mmol/L

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4
Q

Symptoms of hypoglycaemia?

A 
Confusion
Ataxia
Aggression
Slurred Speech
Seizures
Coma
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5
Q

What are some causes for Hypoglycaemia in NON diabetics?

A 
EXPLAIN
EXogenous Drugs (diabetic meds)
Pituitary Insufficienct
Liver failure
Addisons
Insulinoma/Immune
Neoplasia

Dumping syndrome

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6
Q

Treating hypoglycaemia?

A

If unconscious give dextrose IV 20-30g

Conscious - sugary meal/drink

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7
Q

Causes of hypoglycaemia in a diabetic?

A

Overdoing Insulin or sulphonyurea

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8
Q

Investigating hypoglycaemia in NON diabetics?

A

Insulin level:
High - drug induced, insulinoma, dumping
Normal - neoplasia, immune
Low + Ketones - Alcohol, Addisons, Pituitary

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9
Q

What is DKA?

A

Diabetic Ketoacidosis
Seen in Type 1 or insulin dependent diabetics
Hyperglycemia and ketones
Medical Emergency

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10
Q

What causes DKA?

A

Undiagnosed diabetics
Illness
Vomiting/Dehydration
Missed or not increased insulin, diabulemia

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11
Q

Investigations in DKA?

A

ABG/VBG and blood culture
Urine - glucose and ketones, culture
ECG - acidosis can cause hyperkalaemia/vomiting causing hypokalaemia
Bloods - Glucose, U&Es, LFTs, CRP, WCC, amylase
CXR

Diagnosis pH <7.3, ketones or HCO3 under 15

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12
Q

Symptoms of DKA?

A 
Acute Abdomen
Nausea and Vomiting
Headache
Coma/LoC
Dehydration
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13
Q

Treatment of DKA?

A

ABCDE - O2 may be need
Fluids IV + Insulin IV in a driver (50 units/50 mls 0.1units/kg.hour)
NBM for 6 hours
Monitor Urine Output - catheter if no urine in 1 hour
K+ replacement if needed (vomiting)
Infection -BS antibiotics
DVT Prophylaxis

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14
Q

When do you stop the IV insulin?

A

After they have been able to eat and drink

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15
Q

When do you start giving dextrose alongside the insulin?

Why?

A

When the level goes below 14

To stop hypoglycaemia

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16
Q

Signs of DKA?

A

Ketone/Sweet smelling breath
High HR, RR (Kussmal Respiration)
Low Conscious Level

17
Q

When do you treat DKA until?

A

Ketones under 0.3
pH over 7.3
HCO3 over 18

18
Q

What investigations do you do in HONK?

A

Glucose

Bloods - U&Es, CRP, WCC, FBC

19
Q

Treating HONK?

A 
Fluid replacement + K+ if needed
IV Access
Antibiotics, LMWH
Stop Metformin
(insulin if not responding)
20
Q

What is the risk of HONK?

A

Death

Has a higher mortality than DKA

21
Q

What are the changes in Diabetic Retinopathy?

Pre-proliferative

A

Soft Exudates form - from infarction
Cotton Wool Spots
Microaneurysms

22
Q

What are the stages of Diabetic Retinopathy?

A

Early changes
Pre-proliferative
Proliferative

23
Q

What are the changes in Diabetic Retinopathy?

Proliferative?

A

New vessels sprout - they are weak so…

Haemorrhages form

24
Q

What are the complications of Diabetic Retinopathy?

A

Vision Loss:
Chronic
Acute - haemorrhages
Cataracts

25
Q

What are the kidney changes in diabetes?

A

Kimmelstiel deposits in the glomerulus - glomerulosclerosis
BM thickening due to glucose attaching and damaging
Damage to the renal artery due to atherosclerosis
HTN can cause CKD

26
Q

What are the changes in Diabetic Retinopathy?

Early changes

A

Hard Exudates

Microaneurysms

27
Q

How do you monitor renal function in diabetics?

A

U&Es
PCR
Look for microalbuminaemia

28
Q

What are the complications of Peripheral Neuropathy?

A

Charcot joint
glove and stocking sensation loss
Ulcers
Cellulitis

29
Q

What are some other causes of diabetes?

A 
Cushings
Acromegaly
Gestational
Pancreatitis 
MODY
30
Q

What are the diagnosis levels for diabetes?
HbA1c
Fasting GTT
Random OGTT

A

6.5
7
11.1
If symptomatic just need one positive test
If asymptomatic then 2 needed on different occassions

31
Q

what is the level for “pre-diabetes”?

A

<6.7mmol/L

Phase 2 - General Medicine (6 decks)

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