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Year 5 Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the 3 key features of DKA?

A

HyperG >11
Ketones +++ on dipstick or >3 on bloods
Metabolic acidosis: pH <7.3 or HCO3- <15

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2
Q

What are the signs of DKA?

A 
Polyuria &amp; polydipsia
N&amp;V
Weight loss
Confsion &amp; drowsy
Kussmaul breathing
Abdo pain
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3
Q

What is kussmaul breathing?

A

Deep hyperventilation to expel CO2 for respiratory compensation

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4
Q

What investigations should be done for DKA?

A 
Urine dip: +++ ketones, +++ glucose
Blood Glucose: >11
Capillary ketones: >3
ABG: Metabolic acidosis
Other bloods: FBC, U&amp;E, LFT
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5
Q

How is DKA managed?

A

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

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6
Q

Should any regular meds be continued in DKA?

A

ALWAYS continue patients long acting insulin

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7
Q

What is the fluid regimen in DKA?

A 
1L → 1hr
1L → 2hr
1L → 2hr
1L → 4hr
1L → 4hr
1lL→ 6hr
1L → 6hr
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8
Q

What are the complications of DKA?

A

↓Mg: <0.5 then give MgSO4 in 50ml saline over 15-30mins

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9
Q

What is the mechanism of DKA?

A

Too much glucose
Body used all insulin
Lack of insulin causes body to metabolise fat (lipolysis)
Produces ketones

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10
Q

Define hypoG?

A

Glucose <4mmol

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11
Q

What can cause hypoG?

A

DRUGS: Insulin, OH-, beta-blockers, salicylates, sulfonylureas
ORGAN FAILURE: Acute LF, adrenal failure, hypopituitarism
INFECTION
TUMOURS: Insulinoma

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12
Q

What are the clinical features of hypoG?

A 
<3.6= sympathetic overactivity:
- Tachy + anxious
-Sweating + pallor + Tremor
-Cold extremities
<2.6 = neuroglycopenia
-Confusion
-Slurred speech + blurred vision
-Seizures/coma
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13
Q

How is hypoG investigated?

A 
Blood glucose:
<4 = hypoG
<2.2 = Severe attack
< 1.5 = Coma
Other bloods: U&amp;E
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14
Q

How is hypoG managed?

A

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

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15
Q

What is HHS?

A

Severe uncorrected hyperG
In presence of residual insulin production
Usually T2DM
With massive dehydration but NOT ketoacidotic

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16
Q

How does HHS present?

A 
Unknown Hx of DM
Insidious polyuria + polydipsia
SEVERE DEHYRDATION
Weakness- leg cramps
↓Consciousness 
↓BP, ↑HR, ↑RR
17
Q

How is HHS investigated?

A 
Glucose: >33
U&amp;E: ↑Urea > Cr, ↑Na 
FBC: Polycythaemia + leucocytosis
Plasma Osmolality: >350mosm/kg- DIAGNOSTIC
ABG: Normal
18
Q

Why is there an ↑Na in HHS?

A

Glucose draws H2O out of cells
Causes dilution ↓Na
Once Tx started ↑↑Na

19
Q

How is HHS managed?

A

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

20
Q

What is the fluid regimen in HHS?

A

1L → 30mins
1L & K+ → 2hr for 4hr (x2)
1L & K+ → 6hr until rehydrated (usually 48hours)

21
Q

Define T1DM

A

Autoimmune destruction of pancreatic B cells leading to ↓insulin production

22
Q

What are the classic symptoms of T1DM?

A

Polyuria
Polydipsia
Weight loss
Fatigue

23
Q

How is T1DM diagnosed?

A 
1. Clinical Sx of hyperG
AND
- Fasting glucose >7
OR
-Random plasma glucose >11.1
OR
OGTT 2hr post >11.1
OR
HbA1c >48
24
Q

What HbA1c level is classed as pre-diabetic?

A

42-47

25
Q

How is diabetes linked to nephropathy?

A

Glucose damages glomeruli & renal arteries

Need to inhibit RAAS to protect kidneys & control HTN (ACEi/Losartan)

26
Q

What are the signs of diabetic nephropathy?

A

Microalbuminuria: ACR >1
Urine dip: + protein
Urine ACR >3

27
Q

What 9 things need to be considered at an annual diabetic review?

A

1) Weight + BMI
2) Creatinine
3) Urine ACR
4) Cholesterol
5) HbA1c
6) BP (<140/90)
7) Smoking status
8) Eye exam
9) Foot exam

28
Q

What are the blood glucose targets throughout the day?

A

Aim for: 5-7
Waking: 4-7
Pre-meal: 5-9
Post-meal/post-op: 6-10

29
Q

How is T1DM managed?

A

1st line) Basal-bolus insulin

30
Q

How is T2DM managed?

A 
1) Exercise + diet
HbA1c not at target in 3months
2) Metformin OR Gliclazide
HbA1c not at target in 3months
3) Metformin + Gliclazide/DDP-4/Piaglitazone/
HbA1c not at target in 3months
4) Triple therapy OR Insulin
31
Q

What are the 2 main categories of Sx in diabetic neuropathy?

A
  • Neuropathy: Charcot foot/joint = swelling, distortion, flat foot, loss of sensation, neuropathic ulcers (NOT painful on plantar)
  • Ischaemia: Absent foot pulses, ↓ABPI, Intermittent claudication

Year 5 Endocrine (6 decks)

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