Diabetes Flashcards
What are the cardinal symptoms of diabetes?
Dry mouth Polydipsia Polyuria Nocturia Weight loss (or weight gain type 2) Lethargy Increased appetite Blurring of vision Increased infections - UTIs, Thrush DKA
What investigations should be done into suspected diabetes?
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
What are the values for DKA?
Acidosis: pH <7.3 or HCO3- <18
Hyperglycaemia: >14mmol/L
Ketones: >3mmol or ++ on dipstick
What are the signs of DKA?
Dehydration
- furred tongue
Polyuria
Weakness
N&V
Abdominal pain
Blurred vision
Smell of acetone
Kussmaul breathing
Confusion/ coma
Hypotension
What investigations do you want in DKA?
Bloods:
* Glucose * VBG or ABG * Ketones * U&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
In DKA what monitoring should you instigate:
Hourly blood glucose and ketones
K+ levels
U&Es
Clinical monitoring Stats + urine output
What are the risk factors for hypoglycemia in diabetic patients?
Insulin + Sulfonylureas
- missed or delayed meals
- Unexpected exercise
- alcohol
- Poor regime
- Poor absorption of the food (Coeliac, gastric paresis)
- Unrecognised other disorder - Addison’s
What are the complications of DKA?
Cerebral oedema
Hypokalemia
Venous thrombus embolism
Aspiration pneumonia
Acute lung injury
How is type I diabetes managed pre-operatively?
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.
How should be type II diabetics be managed pre-operatively?
All medications stopped 24 hours before except metformin, which is stopped morning of surgery.
What are the complications that occur to vision in diabetes?
Non-proliferative changes
- Dots
- Blots
Proliferative
- Neovascularization
Clinically Significant Macular Oedema
- biggest cause of blindness
Vitreous haemorrhage
- causes sudden vision loss
What are the best preventative measure for diabetic retinopathy?
Glycaemia control
Blood pressure control
Lipid control
What are the types of neuropathy seen in diabetes?
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
What advice should be given to diabetic patient regarding their feet?
Inspect feet daily
Moisturise feet daily
Wear suitable fitting shoewear
Avoid over the counter corn plasters
Annual screening by podiatrist
Do not burst blisters
What are some other causes of diabetes outwith Type1 and type II?
MODY
Haemochromatosis
Acromegaly
Steroids
Hyperthyroidism
Cushing’s disease
What are the risk factors for gestational diabetes?
• >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
What drugs can be used to manage Neuropathic pain?
Gabapentin
Amitriptyline
Pregabalin
**remember that amitriptyline can cause urinary retention so in patients with risk factors for urinary retention should not receive this
Everyone who is treated with insulin should be given what?
Glucagon kit
- for emergencies
What are some risk factors for patients developing hypoglycemia?
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
If a patient has an infection and ketoacidosis, which takes preference?
DKA
- investigate this first and treat first
Type 1 diabetic develops an infection, which important things must be considered?
Insulin onto a sliding scale
Regular manual blood glucose monitoring
Maintain Carbohydrate intake
What is an ulcer called that is a pressure sore?
Decubitus ulcer
What is the management of hypoglycaemia?
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
Triggers to DKA:
Infection Pancreatitis Chemotherapy Anti-psychotics First presentation
When should ICU be contacted regarding DKA?
pH <7.0
Ketones >6
HCO3 <5
GCS <12
What are some important pitfalls to be aware of in DKA?
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
What is infusion rate for DKA?
0.1 units/kg/hour
Why might there be a gut splash in DKA?
Gastroparesis
What are some side effects of given IV glucose?
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
