Diabetes Flashcards
What is Diabetes?
A chronic metabolic disorder
What organ produces the key hormones in controlling blood sugar?
Pancreas
Discuss the role of the pancreas in blood sugar regulation.
The pancreas, located posterior to the stomach and superior to the kidneys contains the islets of langerhans (Pancreatic Cells). These islets contain A cells and B cells which secrete the key hormones involved in blood sugar regulation.
What hormone is produced by the Alpha cells in the Pancreas?
Glucagon
What hormone is produced by the B cells in the Pancreatic cells?
Insulin
What does Glucagon do?
Released from the Alpha cells in the pancreas, Glucagon increases blood sugar by stimulating the liver to convert glycogen to glucose.
What does Insulin do?
Released from the Beta cells in the pancreas, Insulin decreases blood sugar by stimulating the uptake of glucose from the blood into the tissues for storage.
What is Cortisol?
Produced by the adrenal glands, Cortisol is the primary stress hormone. It is produced as part of the flight or flight response and results in an increased level of glucose in the blood. Adrenal crisis is caused due to a lack of Cortisol.
What are some of the key complications/ illnesses associated with diabetes?
MI, Stroke, Renal failure, vascular disease, nerve system damage, blindness
What occurs with diabetes?
Failure to produce (or desensitisation to) insulin and therefore an inability to naturally counteract hyperglycaemia.
What is Type 1 Diabetes?
Also called Insulin Dependant Diabetes Mellitus (IDDM). Occurs as a result of a autoimmune disease that destroys the Beta cells responsible for synthesising insulin.
What is LADA diabetes?
A specific type of diabetes called Latent Autoimmune Disease of Adults. This is type 1 diabetes that occurs in adults usually over 35. LADA develops slowly and so is sometimes misdiagnosed as type 2.
What is type 2 diabetes?
Non insulin dependent diabetes mellitus (NIDDM). This results when cells become desensitised to insulin and so respond poorly to it resulting in hyperglycaemia and also when insulin producing B cells get overworked and become less efficient.
This is usually caused by obesity/ unhealthy lifestyle.
What is Diabetic Ketoacidosis (DKA)?
Ketoacidosis occurs when the lack of circulating insulin forces cells to use alternative sources of fuel for metabolism such as fatty acids. Ketones are a by product of this process and accumulation results in metabolic acidosis.
Ketoacidosis are often caused by steroids and inadequate insulin dosing. Newly diagnosed Type 1 often presents as DKA.
What is hyperosmolar Hyperglycaemic State (HHS)?
HHS occurs in people with type 2 diabetes who experience very high blood glucose levels over a period of weeks.
Presents as DKA without acidosis.
Hypovolemia is key indicator
Hypoglycaemia S&S?
BM <4.0 (in diabetics) Sweating Shaking Heart Palpitations Hunger Nausea, drowsiness, headache Reduced GCS Odd behaviours aggression Poor Coordination
Hyperglycaemia S&S?
BM >7.0 Polydipsia Polyuria Lethargy Weight Loss Recurrent infection blurred vision Fruity breath Ketones Hyperventilation
Diabetic Ketoacidosis (DKA) S&S?
ALL HYPERGLYCAEMIA S&S \+ Vomiting Abdominal Pain Confusion Dehydration Kussmaul breathing (rapid) Other AI diseases such as Addisons
Hypoglycaemia A&M?
Assess ABCDE BM and record Look for medical alert info and care pathway Assess bm (note!) Correct ABCDE problems 40% Gluose 10% IV Glucose Consider Glucagon IM See JRCALC
DKA and HHA A&M?
Limited pre-hospital -Follow ABCDE -Does patient have a blood ketone meter issued to them? Ketone level <0.6 is normal Blood ketone >3 = DKA -Look for medical alert information -Correct life threatening conditions and commence transfer -Consider Iv fluids -Consider Airway intervention if necessary -Consider O2 if necessary -Assess for signs of dehydration -ECG -Bring patient records
What is Addisons disease?
A rare disorder of the adrenal glands interfering with the producing of cortisol and aldosterone. Treatment usually involves steroid treatment to replace these hormones.
Discuss adrenal crisis as related to Addisons disease?
Adrenal crisis is a life threatening emergency caused by a lack of Cortisol.
It is commonly brought on in Addisons patients by vomiting, diarrhoea, infection, surgery.
Patients present with hypotension, shock, acute abdominal pain, vomiting, pyrexia
Adrenal Crisis A&M?
Hydrocortisone
See JRCALC
Fluids and Glucose
In treating Hypoglycaemia Glucagon may be ineffective, why?
Glucagon takes 10 minutes to takes effect and requires patient to have adequate glycogen stores. If the glycogen stores are depleted due to frequent hypoglycaemic episodes, alcohol use then Glucagon will do nothing.
This is very likely in patients who have non-diabetic causes of hypoglycaemia.
What is severe hypoglycaemia?
Patient unconscious, convulsing, very aggressive.
GCS < 8
Severe Hypoglycaemia A&M?
ABCDE
- Admin IV Glucose 10% (IM Glucagon only if IV not possible)
- Nil by mouth
- Titrate to affect (check bm after 10 mins)
- After 10 mins if bm <4 admin further IV 10%
- Continue treatment until bm >4 assessing every 10 minutes
- TCT if no improvement with ATMIST
- If bm > 4 give starchy snack (larger snack if glucagon has been given) continue monitoring
Mild Hypoglycaemia A&M?
Mild = conscious, orientated, can swallow
- If able to swallow admin 15-20 grams of quick acting carbohydrate such as Dextrosol or glucojuice or 1 or two tubes of 40% glucose gel
- Reassess bm after 10-15 mins aiming for 4.0mmol/l
- If no improvement repeat oral treatment up to twice more at 15 mins intervals (Glucagon once only) aiming for >4.0
- If no improvement after 3 cycles give IV glucose 10%
- Once bm >4 give starchy snack (larger snack if glucagon has been given)
- Transfer if necessary or leave at home if not see JRCALC for guidance
Moderate Hypoglycaemia A&M?
Moderate = conscious, can swallow, dis-orientated
- If able to swallow admin 15-20 grams of quick acting carbohydrate such as Dextrosol or glucojuice or 1 or two tubes of 40% glucose gel if not capable
- Reassess bm after 15 mins
- If <4 repeat admin
- If 40% glucose gel cannot be used, use IV 10% glucose
- If no improvement repeat treatment up to twice more at 15 mins intervals (Glucagon once only) aiming for >4.0
- After obtaining bm > 4 give starchy snack and continue to monitor
