Diabetes Flashcards
What is HONK?
Hyperosmolar Non-Ketogenic hyperglycaemia
Like DKA but in non-insulin dependent diabetics.
Has a longer onset of dehydration
What causes HONK?
Normally set off by an illness (UTI, pneumonia)
Seen in older or non-diagnosed diabetics
What is the level for hypoglycaemia?
<3mmol/L
Symptoms of hypoglycaemia?
Confusion Ataxia Aggression Slurred Speech Seizures Coma
What are some causes for Hypoglycaemia in NON diabetics?
EXPLAIN EXogenous Drugs (diabetic meds) Pituitary Insufficienct Liver failure Addisons Insulinoma/Immune Neoplasia
Dumping syndrome
Treating hypoglycaemia?
If unconscious give dextrose IV 20-30g
Conscious - sugary meal/drink
Causes of hypoglycaemia in a diabetic?
Overdoing Insulin or sulphonyurea
Investigating hypoglycaemia in NON diabetics?
Insulin level:
High - drug induced, insulinoma, dumping
Normal - neoplasia, immune
Low + Ketones - Alcohol, Addisons, Pituitary
What is DKA?
Diabetic Ketoacidosis
Seen in Type 1 or insulin dependent diabetics
Hyperglycemia and ketones
Medical Emergency
What causes DKA?
Undiagnosed diabetics
Illness
Vomiting/Dehydration
Missed or not increased insulin, diabulemia
Investigations in DKA?
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
Symptoms of DKA?
Acute Abdomen Nausea and Vomiting Headache Coma/LoC Dehydration
Treatment of DKA?
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
When do you stop the IV insulin?
After they have been able to eat and drink
When do you start giving dextrose alongside the insulin?
Why?
When the level goes below 14
To stop hypoglycaemia
Signs of DKA?
Ketone/Sweet smelling breath
High HR, RR (Kussmal Respiration)
Low Conscious Level
When do you treat DKA until?
Ketones under 0.3
pH over 7.3
HCO3 over 18
What investigations do you do in HONK?
Glucose
Bloods - U&Es, CRP, WCC, FBC
Treating HONK?
Fluid replacement + K+ if needed IV Access Antibiotics, LMWH Stop Metformin (insulin if not responding)
What is the risk of HONK?
Death
Has a higher mortality than DKA
What are the changes in Diabetic Retinopathy?
Pre-proliferative
Soft Exudates form - from infarction
Cotton Wool Spots
Microaneurysms
What are the stages of Diabetic Retinopathy?
Early changes
Pre-proliferative
Proliferative
What are the changes in Diabetic Retinopathy?
Proliferative?
New vessels sprout - they are weak so…
Haemorrhages form
What are the complications of Diabetic Retinopathy?
Vision Loss:
Chronic
Acute - haemorrhages
Cataracts
