Diabetes - Clinical Case Flashcards
A 28-year-old woman presents to the Accident and Emergency department with nausea and vomiting. She is due to get married in 3 months and has lost 1 stone in weight over the last 5 weeks, which she put down to getting a personal trainer. However, she has cancelled her recent gym classes due to tiredness. She has noticed blurred vision over the last few weeks. She looks unwell and is struggling to hold a conversation due to vomiting.
Summary of issues:
* Nausea and vomiting
* Weight loss
* Tiredness
* Blurred vision
What is your differential diagnosis?
- Type 1 Diabetes
- Type 2 Diabetes
- Abdominal Malignancy
- Pregnancy
- Stress / Anxiety
- Hyperthyroidism
- Gastroenterities
- Addison’s Disease
A 28-year-old woman presents to the Accident and Emergency department with nausea and vomiting. She is due to get married in 3 months and has lost 1 stone in weight over the last 5 weeks, which she put down to getting a personal trainer. However, she has cancelled her recent gym classes due to tiredness. She has noticed blurred vision over the last few weeks. She looks unwell and is struggling to hold a conversation due to vomiting.
Summary of issues:
* Nausea and vomiting
* Weight loss
* Tiredness
* Blurred vision
She is waking up three times a night and passing large volumes of urine and sleeps with a large bottle of water by her bedside. The blurred vision is intermittent, and she finds it difficult to focus on her laptop screen. There has been no change in bowel habit. She also reports being treated twice for a urine infection in the last 2 months.
In view of this further history, what is the most likely diagnosis? What is the explanation for the symptoms and signs that she presents with?
Type 1 Diabetes Mellitus
* Polyuria
* Polydipsia
* Nocturia
* UTI
A 28-year-old woman presents to the Accident and Emergency department with nausea and vomiting. She is due to get married in 3 months and has lost 1 stone in weight over the last 5 weeks, which she put down to getting a personal trainer. However, she has cancelled her recent gym classes due to tiredness. She has noticed blurred vision over the last few weeks. She looks unwell and is struggling to hold a conversation due to vomiting.
Summary of issues:
* Nausea and vomiting
* Weight loss
* Tiredness
* Blurred vision
She is waking up three times a night and passing large volumes of urine and sleeps with a large bottle of water by her bedside. The blurred vision is intermittent, and she finds it difficult to focus on her laptop screen. There has been no change in bowel habit. She also reports being treated twice for a urine infection in the last 2 months.
What immediate bedside tests would you wish to perform at this point?
- Urinanalysis / Urine dip stick (Ketonuria)
- Capillary Blood Glucose (Finger prick test)
- Arterial Blood Gas
A 28-year-old woman presents to the Accident and Emergency department with nausea and vomiting. She is due to get married in 3 months and has lost 1 stone in weight over the last 5 weeks, which she put down to getting a personal trainer. However, she has cancelled her recent gym classes due to tiredness. She has noticed blurred vision over the last few weeks. She looks unwell and is struggling to hold a conversation due to vomiting.
Summary of issues:
* Nausea and vomiting
* Weight loss
* Tiredness
* Blurred vision
She is waking up three times a night and passing large volumes of urine and sleeps with a large bottle of water by her bedside. The blurred vision is intermittent, and she finds it difficult to focus on her laptop screen. There has been no change in bowel habit. She also reports being treated twice for a urine infection in the last 2 months.
You obtain the patients’ venous blood gas results:
* pH: 6.9 (7.35-7.45)
* Glucose: 28 mmol/L
* Bicarbonate: 5 mmol/L (22-29)
* Capillary blood ketones: 5.2 mmol/L (< 1 mmol/L)
Work through these blood results and describe what is normal or abnormal about them. Do these confirm your diagnosis?
Diabetic Ketoacidosis:
* Acidosis
* Hyperglycaemia
* Metabolic Acidosis
* Ketosis
A 28-year-old woman presents to the Accident and Emergency department with nausea and vomiting. She is due to get married in 3 months and has lost 1 stone in weight over the last 5 weeks, which she put down to getting a personal trainer. However, she has cancelled her recent gym classes due to tiredness. She has noticed blurred vision over the last few weeks. She looks unwell and is struggling to hold a conversation due to vomiting.
Summary of issues:
* Nausea and vomiting
* Weight loss
* Tiredness
* Blurred vision
She is waking up three times a night and passing large volumes of urine and sleeps with a large bottle of water by her bedside. The blurred vision is intermittent, and she finds it difficult to focus on her laptop screen. There has been no change in bowel habit. She also reports being treated twice for a urine infection in the last 2 months.
You obtain the patients’ venous blood gas results:
* pH: 6.9 (7.35-7.45)
* Glucose: 28 mmol/L
* Bicarbonate: 5 mmol/L (22-29)
* Capillary blood ketones: 5.2 mmol/L (< 1 mmol/L)
What is responsible for the acidosis and why does this occur?
Glycogen stores low due to glucose not being stored -> fat lipolysis for energy -> increase in ketone bodies -> charged ions leading to increase in H+ -> drop in blood pH -> acidosis
A 28-year-old woman presents to the Accident and Emergency department with nausea and vomiting. She is due to get married in 3 months and has lost 1 stone in weight over the last 5 weeks, which she put down to getting a personal trainer. However, she has cancelled her recent gym classes due to tiredness. She has noticed blurred vision over the last few weeks. She looks unwell and is struggling to hold a conversation due to vomiting.
Summary of issues:
* Nausea and vomiting
* Weight loss
* Tiredness
* Blurred vision
She is waking up three times a night and passing large volumes of urine and sleeps with a large bottle of water by her bedside. The blurred vision is intermittent, and she finds it difficult to focus on her laptop screen. There has been no change in bowel habit. She also reports being treated twice for a urine infection in the last 2 months.
You obtain the patients’ venous blood gas results:
* pH: 6.9 (7.35-7.45)
* Glucose: 28 mmol/L
* Bicarbonate: 5 mmol/L (22-29)
* Capillary blood ketones: 5.2 mmol/L (< 1 mmol/L)
What treatment does she need immediately?
- IV fluids
- High dose of short acting insulin
- Monitor glucose
A 28-year-old woman presents to the Accident and Emergency department with nausea and vomiting. She is due to get married in 3 months and has lost 1 stone in weight over the last 5 weeks, which she put down to getting a personal trainer. However, she has cancelled her recent gym classes due to tiredness. She has noticed blurred vision over the last few weeks. She looks unwell and is struggling to hold a conversation due to vomiting.
Summary of issues:
* Nausea and vomiting
* Weight loss
* Tiredness
* Blurred vision
She is waking up three times a night and passing large volumes of urine and sleeps with a large bottle of water by her bedside. The blurred vision is intermittent, and she finds it difficult to focus on her laptop screen. There has been no change in bowel habit. She also reports being treated twice for a urine infection in the last 2 months.
You obtain the patients’ venous blood gas results:
* pH: 6.9 (7.35-7.45)
* Glucose: 28 mmol/L
* Bicarbonate: 5 mmol/L (22-29)
* Capillary blood ketones: 5.2 mmol/L (< 1 mmol/L)
She improves with treatment over the next 12 hours. Her vomiting has settled and she is eating and drinking normally.
What treatment does she need for discharge?
- Basal bolus regime
- Insulin short & long acting
- Carbohydrates / DM education
- Diabetes specialist nurse
- Capillary blood glucose measuring equipment
