diabetes complications Flashcards
mechanism DKA
lack of insulin –> lipolysis –> excess fatty acids –> ketones
what can precipitate a DKA
infection, missed insulin, MI
symptoms DKA
abdo pain, polyuria, dehdrated, kussmaul breathing, pear drop breath, reduced LOC
diagnosis DKA (british)
glucose >11 or known DM // pH <7.3 // bicarb <15 // ketones >3 or ketonuria // (anion gap >10)
mx DKA
isotonic saline (0.9% NaCl) // insulin 0.1 unit/kg/hr // correct U+E (esp K)
when should dextrose be used in DKA + how is it administered
when glucose <14 // add 10% dextrose to 0.9% NaCl
what insulin regimes should be continued/ stopped in DKA
continue long acting, stop short acting
when should potassium be given in DKA and at what rate
if K between 3.5-5.5 // 40 mmol/L
what invx define DKA resolution
pH >7.3 // blood ketones <0.6 // bicarb >15
when should ketonaemia + acidosis have resolved by in DKA
24 hours // if not –> endocrinologist
when can subcut insulin be restarted following DKA
after resolution
complications DKA (6)
gastric stasis // thromboembolism // arrhythmia // cerebral oedema // ARDS // AKI
what can cause cerebral oedema in DKA
fluid rescuss
who is most likely to get cerebral oedema in DKA
young people
symptoms cerebral oedema DKA
headache, irritible, vision, focal neuro
who gets HHs
elderly T2DM
mechanism HHS
hyperglycaemia –> raised serum osmolality –> osmotic diuresis –> dehydration + electrolyte imbalance
RF HHS
illness // dementia // sedative drugs
onste of HHS vs DKA
DKA sudden, HHS slower over days
symptoms HHS
dehydrated // polyuria + dipsia // tired // N+V // reduced LOC // focal neuro // hyperviscous –> MI, stroke
diagnosis HHS
hypovolaemia // marked hyperglycaemia (>30) // raised serum osmolarity (>320) // NO ketones or acidosis
mx HHS
0.9% NaCl over 0.5-1L/hr // VTE prophylaxis
when should insulin be given HHS
ONLY if blood glucose STOPS falling when giving fluids
complications HHS
MI or stroke (from hyperviscocity)
what type of peripheral neuropathy to diabetics experience + what part of body is affected
sensory // glove and stocking, esp lower legs
1st line mx peripheral diabetic neuropathy
amitrip, duloxetine, gabapentin, pre-gabalin
what should be done if 1st line mx does not work diabetic peripheral neuropathy
try one of the other 3
alternative mx diabetic peripheral neuropathy (3)
tramadol as rescue therapy // topical capsaican // pain mx clinics
what conditions can diabetic GI autonomic neuropathy cause (3)
gastroparesis // diarrhoea // GORD
symptoms diabetic gastroparesis
erratic glucose control // bloating // vomiting
mx diabetic gastric paresis
prokinetic agents eg metoclopramide, domperidone, erythromycin
what factors contribute to diabetic foot disease
neuropathy + PAD
symptoms diabetic food disease
loss of sensation // ischaemia (pulses, reduced ABPI, claudication) // ulcers // charcot // osteomyleitis
how is diabetic foot screened for
yearly // ischaemia (pulses) // neuropathy (monofilament)
symptoms low risk diabetic foot disease
only callus
symptoms moderate risk diabetic foot disease
deformity. neuropathy OR non-critical limb ischaemia
symptoms high risk diabetic foot disease
revious ulcer or amputation // renal failure // neuropathy AND non-critical limb ischaemia // neuropathy AND callus or deformity
what is a charcot joint
sensory neuropathy –> lots of damage
how does alcoholic ketoacidosis occur
starvation/ vomiting –> lipolysis –> ketones
findings alcoholic ketoacidosis
metabolic acidosis // raised anion gap // raised ketones // normal glucose
mx alcoholic ketoacidosis
IV saline + thiamine
diabetic screening for nephropathy
albumin:creatinine ration (ACR) // >2.5 = microalbuminuria
BP aim diabetic nephropathy
130/80
mx diabetic nephropathy + indications for therapy
ACEi or ARB if ACR >3
most common cause blindness 35-65
diabetes
mechanism diabetes –> retinopathy
hyperglycaemia –> increased vascular permeability –> exudate –> microanurysm –> neovascularisation
non-proliferative diabetic retinopathy (NPDR) vs proliferative retinpathy (PDR)
NPDR = no neovascularisation
features mild NPDR
1 or more microaneurysm
features moderate NPDR (4)
microaneurysms // blot haemorrhage // hard exudate // cotton wool spot, IRMA
what causes cotton wool spots
soft exudate // from areas of retinal infarction
features severe NPDR
blot haemorrhages + microaneurysms 4 quadrants // venous bleeding 2 quadrants // IRMA 1+ quadrant
features proliferative diabetic retinopathy
neovascularation, fibrous tissue
who is proliferative diabetic retinopathy most common in
T1DM
mx diabetic maculopathy
intravitreal VEGFi
mx NPDR
observation (v severe –> laser)
