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Phase 4 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the cardinal symptoms of diabetes?

A 
Dry mouth 
Polydipsia
Polyuria 
Nocturia 
Weight loss (or weight gain type 2) 
Lethargy 
Increased appetite
Blurring of vision 
Increased infections - UTIs, Thrush 
DKA
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2
Q

What investigations should be done into suspected diabetes?

A

Bloods:

  • Glucose level
  • OGTT: >11.1
  • Fasting glucose >6.9
  • HbA1C >48 mmol/ 6.5%

Autoantibodies:

  • Islet cell autoantibodies
  • Insulin cell autoantibodies
  • Zinc transporter 8 autoantibodies
  • GAD autoantibodies

Urine:
- Dip stick - glucose, ketones

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3
Q

What are the values for DKA?

A

Acidosis: pH <7.3 or HCO3- <18

Hyperglycaemia: >14mmol/L

Ketones: >3mmol or ++ on dipstick

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4
Q

What are the signs of DKA?

A

Dehydration
- furred tongue

Polyuria

Weakness

N&V

Abdominal pain

Blurred vision

Smell of acetone

Kussmaul breathing

Confusion/ coma

Hypotension

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5
Q

What investigations do you want in DKA?

A

Bloods:

* Glucose 
* VBG or ABG
* Ketones 
* U&amp;Es 
* Blood osmolality 
* Blood cultures - if evidence of infection

Orifices:

* Urine dipstick (ketones, glucose)
* MSU

X-rays:
- Only if evidence of infection

ECG:
- If evidence of arrythmias

Special tests:
Blood osmolality

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6
Q

In DKA what monitoring should you instigate:

A

Hourly blood glucose and ketones
K+ levels
U&Es
Clinical monitoring Stats + urine output

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7
Q

What are the risk factors for hypoglycemia in diabetic patients?

A

Insulin + Sulfonylureas

  • missed or delayed meals
  • Unexpected exercise
  • alcohol
  • Poor regime
  • Poor absorption of the food (Coeliac, gastric paresis)
  • Unrecognised other disorder - Addison’s
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8
Q

What are the complications of DKA?

A

Cerebral oedema

Hypokalemia

Venous thrombus embolism

Aspiration pneumonia

Acute lung injury

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9
Q

How is type I diabetes managed pre-operatively?

A

Admitted night before. Insulin is reduced by 1/3rd

First in operation. Omit insulin. Start slide and scale insulin.

Whilst NIL by Mouth patient is started on dextrose.
- BMs should be checked every 2 hours.

Continue slide and scale until patient is eating again, in which there is an overlap between ending slide and scale and starting their insulin.

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10
Q

How should be type II diabetics be managed pre-operatively?

A

All medications stopped 24 hours before except metformin, which is stopped morning of surgery.

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11
Q

What are the complications that occur to vision in diabetes?

A

Non-proliferative changes

  • Dots
  • Blots

Proliferative
- Neovascularization

Clinically Significant Macular Oedema
- biggest cause of blindness

Vitreous haemorrhage
- causes sudden vision loss

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12
Q

What are the best preventative measure for diabetic retinopathy?

A

Glycaemia control
Blood pressure control
Lipid control

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13
Q

What are the types of neuropathy seen in diabetes?

A

Symmetrical sensory polyneuropathy

  • impaired sensation
  • glove and stock pattern
  • clawing of lumbricals

Asymmetrical motor neuropathy

  • severe muscle weakness
  • severe pain
  • Bed bound
  • usually recover occurs

Mononeuropathy:

  • severe and rapid onset, usually recover
  • 3rd nerve palsies

Autonomic neuropathy:

  • postural hypotension
  • Gastroparesis
  • erectile dysfunction
  • Anhidrosis
  • Constipation
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14
Q

What advice should be given to diabetic patient regarding their feet?

A

Inspect feet daily
Moisturise feet daily
Wear suitable fitting shoewear
Avoid over the counter corn plasters

Annual screening by podiatrist

Do not burst blisters

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15
Q

What are some other causes of diabetes outwith Type1 and type II?

A

MODY

Haemochromatosis

Acromegaly

Steroids

Hyperthyroidism

Cushing’s disease

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16
Q

What are the risk factors for gestational diabetes?

A 
• >25 years old 
	• BMI >30 
	• Twins 
	• Previous large baby - >4.5kg (average is 3kg)
	• Previous gestational diabetes 
	• Family history of diabetes 
South Asian, Black Caribbean
17
Q

What drugs can be used to manage Neuropathic pain?

A

Gabapentin
Amitriptyline
Pregabalin

**remember that amitriptyline can cause urinary retention so in patients with risk factors for urinary retention should not receive this

18
Q

Everyone who is treated with insulin should be given what?

A

Glucagon kit

- for emergencies

19
Q

What are some risk factors for patients developing hypoglycemia?

A

Impaired counter regulatory hormones
- long standing disease

Intensive insulin regimen

Previous Hypoglycaemia
- reduced awareness

New renal impairment
- kidneys break down insulin

Change in regime

Lipodystrophy
- reduces the absorption ability

Gastroparesis

20
Q

If a patient has an infection and ketoacidosis, which takes preference?

A

DKA

- investigate this first and treat first

21
Q

Type 1 diabetic develops an infection, which important things must be considered?

A

Insulin onto a sliding scale
Regular manual blood glucose monitoring
Maintain Carbohydrate intake

22
Q

What is an ulcer called that is a pressure sore?

A

Decubitus ulcer

23
Q

What is the management of hypoglycaemia?

A

Consciousness:
- sugary snack

Reduced consciousness:
- Buccal glucose

Unconsciousness:

  • IV glucose/ dextrose
  • IM glucagon

Once patient has recovered with a blood glucose of>4mmol/L
give long acting carbohydrate

24
Q

Triggers to DKA:

A 
Infection 
Pancreatitis 
Chemotherapy 
Anti-psychotics
First presentation
25
Q

When should ICU be contacted regarding DKA?

A

pH <7.0
Ketones >6
HCO3 <5
GCS <12

26
Q

What are some important pitfalls to be aware of in DKA?

A

Creatinine may not reflect actual renal function. Ketones interfere with measurement of it.

WCC may be raised without infection

Amylase can be very high due to the DKA

Infection can often have no fever associated

27
Q

What is infusion rate for DKA?

A

0.1 units/kg/hour

28
Q

Why might there be a gut splash in DKA?

A

Gastroparesis

29
Q

What are some side effects of given IV glucose?

A

GLucose is high irritant to the vessels causing thrombophlebitis
- doses of >20% should be given through central access

Person with thiamine deficiency should also be given parbanex to avoid wernicke’s

Phase 4 (49 decks)

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