Diabetes and its complications

Question 1

What is used to manage dehydration and and ketosis(acidosis) in type 1 DM

Answer 1

Fluids and electrolytes

Question 2

acute complications of diabetes

Answer 2

HYpoglycaemia- T1&T2

Diabetic ketoacidosis (hyperglycaemia) - T1

HYperosmolar hyperglycaemic state T2

Question 3

What is hypoglycaemia and when do symptoms present

Answer 3

Blood glucose <4mmol/L

Symptoms present - 3mmol/L

Question 4

Causes of hypoglycaemia in T1

Answer 4

Insulin overdose

Excessive exercise

Inadequate CHO intake relative to insulin dose

Question 5

Causes of hypoglycaemia in T2

Answer 5

Sulphonylureas (drug that stimulates insulin release)

Hepatic or renal disease

Question 6

Symptoms of hypoglycaemia and why

Answer 6

Palpitations
Tremors
Sweating
Anxiety
Dizziness
Hunger
Irritability
Headache
Tingly lips 

Because of counter- regulatory activity of SNS

Question 7

What happens if hypoglycaemia persists and symptoms

Answer 7

Get glucose deficiency in brain (neuroglycopaenia)

• Loss of concentration
• Slurred speech
• Behaviour/mood changes
• Seizures
• Loss of consciousness

Question 8

Treatment of hypoglycaemia if conscious and unconscious

Answer 8

(conscious) Sugary stuff like biscuits and tea, lucozade, Glucogel (rapid way of getting glucose into blood)
(unconscious) EMERGENCY: glucose intravenously OR glucagon i.m, i.v but not after alcohol

Question 9

What is diabetic ketoacidosis and what are the causes

Answer 9

Hyperglycaemia and metabolic acidosis (ketosis)

• Ommission or reduction in insulin dose
• Illness/infection
• Emotional upset
• Menstruation/pregnancy ketosis
• rare syndromes of insulin resistance in T2

Question 10

What happens when there is diabetic ketoacidosis

Answer 10

-increase in glucose:
Osmotic diuresis (frequency passing urine, dehydration, thirst), glycosuria 

-Increase in ketones:
Nausea, vomiting, breathlessness, abdominal pain

Question 11

If not treated, what can an increase in glucose and ketones lead to

Answer 11

Glucose:

• peripheral circulatory fialure
• Renal failure
• Low cerebral blood flow

Ketones:

• CNS depression
• Diabetic coma

Both ultimately lead to death

Question 12

How to treat diabetic ketoacidosis

Answer 12

It is a medical emergency

insulin i.v. infusion
(suppresses ketogenesis, reduces blood glucose and corrects electrolyte balance)

Replacement of fluids, electrolytes (saline, may need kcl, glucose)

Treat underlying cause

Question 13

What is hyperosmolar hyperglycaemic state

Answer 13

Severe hyperglycaemia without ketosis (T2)

Managed as DKA (less insulin)

Question 14

What is essential for good glycemic control and how

Answer 14

Regular monitoring

• GLucose meter and test strips for T1
• Flash glucose monitor which measures glucose in interstitial fluid
• HbA1c

Question 15

What are microvascular long-term complications of DM

Do these complications occur in patients without diabetes?

Answer 15

MIcrovascular- capillary damage leads to:

Retinopathy (eye disease)

Nephropathy (kidney disease)

Neuropathy (nerve damage)

These do not occur in non-diabetic patients

Question 16

What are macrovascular long-term complications of DM

Answer 16

Medium to large blood vessels

cardiovascular disease (ischaemic heart disease)

Cerebral vascular disease (stroke)

Peripheral vascular disease

Question 17

What can lead to microvascular complications

Answer 17

damage to small vessels by hyperglycaemia and glycation of proteins

Question 18

What can happen in retinopathy

Answer 18

MIcroaneurysms 
Haemorrhages
Exudates (leaking fluid)
Proliferation of new vessels
Pre-proliferation (blood vessels have not yet started to form)
Maculopathy (when macula is affected)

Question 19

In images of the eye, what do cotton-wool spots indicate

Answer 19

Regions of ischaemia (blurring of vision)

Question 20

Why is proliferative retinopathy a problem

Answer 20

New blood vessels form. The walls are not that stable so prone to haemorrhages. Recurrence of this is common. there is an impairment of vision- ‘floaters’, clouding or loss of vision

Question 21

How does nephtopathy develop with poorly controlled diabetes

Answer 21

Early- microalbuminuria

Later- proteinuria, increased BP, decreased eGFR

Advanced-End stage renal disease

Question 22

What drugs can help limit nephropathy and when should they be used

Answer 22

ACE inhibitors because they are renoprotective.

Used when there is even a slight sign of nephropathy, even if the blood pressure is normal

Question 23

Symptoms of neuropathy from diabetes

Answer 23

Loss of sensation
Tingling
Shooting pains
Cramps
Causalgia (an inappropriate sensation e.g. if touched, it may burn)

-Increased risk of foot ulcers

Question 24

Symptoms of peripheral vascular disease

Answer 24

Intermittent claudication (pain), ulceration

Risk of gangrene, amputation

Risk of other vascular events

Diabetic foot ulcers: poor blood supply. Neuropathy, susceptible to infection

Question 25

How to decrease risk of microvascular damage in DM

What should blood pressure targets be for someone with diabetes

Answer 25

• Good glycaemic control
• Control of hypertension (ACEi)

Systolic<140mmHg, diastolic <80mmHg

BUT if with secondary complications, <130, <80 advised

Question 26

How to prevent macrovascular damage in those with diabetes

Answer 26

GOod glycaemic control
Control of hypertension
Control of dyslipidaemia (statins)
Use anti platelet drugs (low dose aspirin, clopidogrel)