Diabetes

Question 1

What is diabetes ketoacidosis (DKA)?

Answer 1

A serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes.

DKA happens when your blood sugar is very high and ketones (acidic) build up to dangerous levels in your body.

Question 2

If the patient is critically unwell, what approach should first be used?

Answer 2

Airway
Breathing
Circulation
Disability
Exposure

Question 3

Aetiology of DKA?

a) Glucose levels
b) Ketone levels
c) Acidosis/Alkalosis

Answer 3

a) Hyperglycaemia: blood glucose > 11.0mmol/L (or known DK)
b) Ketonaemia: ketones > 3.0mmol/L (or significant ketonuria)
c) Acidosis: bicarbonate (HCO3-) < 15.0mmol/L and/or venous pH < 7.3

Question 4

What can cause DKA?

Answer 4

Absolute insulin deficiency (e.g. type 1 diabetes)

Complete insulin insensitivity (e.g. insulin-dependent type 2 diabetes)

Question 5

Typical symptoms of DKA?

Answer 5

• Palpitations
• Nausea
• Vomiting
• Sweating
• Thirst
• Weight loss
• Leg cramps

Question 6

Clinical signs of DKA?

Answer 6

Tachycardia
Hypotension
Reduced skin turgor
Dry mucous membranes
Reduced urine output
Altered consciousness (e.g. confusion, coma)
Kussmaul breathing

Question 7

What is Kussmaul breathing?

Answer 7

Patients with DKA may develop deep, laboured breathing (Kussmaul breathing) in a response to metabolic acidosis (i.e. respiratory compensation).

Question 8

What blood tests should be performed?

Answer 8

• FBC
• U&Es
• TFT
• Fasting glucose
• HbA1c
• CRP
• Arterial blood gas
• Capillary blood glucose

Question 9

What vital signs tested should be performed?

Answer 9

• RR
• Temp
• HR

Question 10

What would you expect the RR to be like?

Answer 10

Deep, laboured breathing (known as Kussmaul breathing)

Question 11

What would you expect the arterial blood gas results to be?

a) Pa)2
b) PaC)2
c) pH
d) HC03-

Answer 11

a) PaO2: may be reduced in the context of pneumonia (e.g. DKA precipitated by a respiratory infection).
b) PaCO2: may be low in the context of DKA due to respiratory compensation as a result of metabolic acidosis.
c) pH: low in the context of DKA due to the presence of acidic ketones.
d) HCO3-: low in the context of DKA due to metabolic acidosis.

Question 12

What would you expect HR to be?

Answer 12

Tachycardia is common in the context of DKA due to hypovolaemia and catecholamine release.

Bradycardia is a late sign and often precedes cardiac arrest.

Question 13

What are the HbA1c values for:

a) normal
b) pre diabetic
c) diabetic

Answer 13

a) <42 mmol/mol
b) 42-47 mmol/mol
c) >47 mmol/mol

Question 14

How can DKA affect the patient’s consciousness?

How can this be assessed?

Answer 14

In DKA, a patient’s consciousness level may be reduced.

Assess the patient’s level of consciousness using the AVPU scale: Alert, Verbal, Pain, Unresponsive

Question 15

Urinalysis must be performed in the case of DKA. What are you testing for?

Answer 15

Glucose and ketone levels in urine

Question 16

What would you expect to see during urinlaysis?

Answer 16

Increased ketones and increased glucose in urine

Question 17

What results would you expect to see for capillary blood glucose? What are the normal ranges?

Answer 17

Increased

Normal range 4-7

Question 18

Wha results would you expect to see for fasting glucose? What are the normal ranges?

Answer 18

Normal: 4.0 – 5.8 mmol/l

Expect to be increased