Diabetes Flashcards
What are the 3 key features of DKA?
HyperG >11
Ketones +++ on dipstick or >3 on bloods
Metabolic acidosis: pH <7.3 or HCO3- <15
What are the signs of DKA?
Polyuria & polydipsia N&V Weight loss Confsion & drowsy Kussmaul breathing Abdo pain
What is kussmaul breathing?
Deep hyperventilation to expel CO2 for respiratory compensation
What investigations should be done for DKA?
Urine dip: +++ ketones, +++ glucose Blood Glucose: >11 Capillary ketones: >3 ABG: Metabolic acidosis Other bloods: FBC, U&E, LFT
How is DKA managed?
1) FLUIDS: 0.9% NaCl
2) Insulin: 50u Actrapid w/50ml saline fixed rate 0.1u/kg/hr
Once glucose <14 → 10% glucose continued till ketones <0.3, pH .7.3, HCO3- >18
3) K+ Sulphate 40mls at 125ml/hr in 2nd bag of NaCl
Should any regular meds be continued in DKA?
ALWAYS continue patients long acting insulin
What is the fluid regimen in DKA?
1L → 1hr 1L → 2hr 1L → 2hr 1L → 4hr 1L → 4hr 1lL→ 6hr 1L → 6hr
What are the complications of DKA?
↓Mg: <0.5 then give MgSO4 in 50ml saline over 15-30mins
What is the mechanism of DKA?
Too much glucose
Body used all insulin
Lack of insulin causes body to metabolise fat (lipolysis)
Produces ketones
Define hypoG?
Glucose <4mmol
What can cause hypoG?
DRUGS: Insulin, OH-, beta-blockers, salicylates, sulfonylureas
ORGAN FAILURE: Acute LF, adrenal failure, hypopituitarism
INFECTION
TUMOURS: Insulinoma
What are the clinical features of hypoG?
<3.6= sympathetic overactivity: - Tachy + anxious -Sweating + pallor + Tremor -Cold extremities <2.6 = neuroglycopenia -Confusion -Slurred speech + blurred vision -Seizures/coma
How is hypoG investigated?
Blood glucose: <4 = hypoG <2.2 = Severe attack < 1.5 = Coma Other bloods: U&E
How is hypoG managed?
1) Safe swallow → Fast acting glucose 10-20g
RECHECK GLUCOSE 10-15mins → Rx if <4
2) Unsafe swallow → IV 100ml 20% glucose OR IM glucagon 1mg
3) Carb rich snack when able to eat
4) Consider cause, Alcoholic → IV Pabrinex
What is HHS?
Severe uncorrected hyperG
In presence of residual insulin production
Usually T2DM
With massive dehydration but NOT ketoacidotic
How does HHS present?
Unknown Hx of DM Insidious polyuria + polydipsia SEVERE DEHYRDATION Weakness- leg cramps ↓Consciousness ↓BP, ↑HR, ↑RR
How is HHS investigated?
Glucose: >33 U&E: ↑Urea > Cr, ↑Na FBC: Polycythaemia + leucocytosis Plasma Osmolality: >350mosm/kg- DIAGNOSTIC ABG: Normal
Why is there an ↑Na in HHS?
Glucose draws H2O out of cells
Causes dilution ↓Na
Once Tx started ↑↑Na
How is HHS managed?
1) FLUID replacement: 1/2 rate of DKA, 0.9% NaCl
If Na >160 use 0.45% NaCl for 3L
2) VTE prophylaxis → Tinz
3) If ketonuria → Insulin infusion
What is the fluid regimen in HHS?
1L → 30mins
1L & K+ → 2hr for 4hr (x2)
1L & K+ → 6hr until rehydrated (usually 48hours)
Define T1DM
Autoimmune destruction of pancreatic B cells leading to ↓insulin production
What are the classic symptoms of T1DM?
Polyuria
Polydipsia
Weight loss
Fatigue
How is T1DM diagnosed?
1. Clinical Sx of hyperG AND - Fasting glucose >7 OR -Random plasma glucose >11.1 OR OGTT 2hr post >11.1 OR HbA1c >48
What HbA1c level is classed as pre-diabetic?
42-47
