Diabetes Lecture 4: Diabetes and its complications Flashcards
What causes increased mortality in diabetic patients
Increased incidence of cardiovascular disease and renal failure
What causes increase morbidity in diabetic patients
Increased incidence of blindness and amputation
What are the short term complications of diabetes
Hypoglycaemia
Diabetic Ketoacidosis (DKA)
Hyperosmolar hyperglycaemic state (HHS)
What are the long term complications of diabetes
Retinopathy
Cardiovascular Disease
Neuropathy
Nephropathy
Macrovascular: CVD, stroke, extremities (feet)
Microvascular: Eye, kidney, nerves and skin
When does hypoglycaemia occur and what are the symptoms
Blood glucose falls below 4mmol/L
Symptoms: Shaking Sweating Anxious Impaired vision Hunger Fatigue Headache Irritable
What are the causes of hypoglycaemia
Too much insulin or sulfonylureas- patient, doctor or pharmacist error
Altered insulin absorption- absorbed more rapidly from abdomen
Altered insulin clearance- reduced clearance in renal failure
Decreased insulin requirements:
Missed, small, delayed meals
Exercise: increases insulin absorption
Alcohol: inhibits hepatic glucose output
How do you treat symptoms of hypoglycaemia
Recognise signs and symptoms as soon as possible
Use oral glucose if conscious and able to swallow- tablets, sugary drinks, sweets
Use intramuscular or subcutaneous glucagon, intravenous glucose if patient is unconciousess
How does glucagon work in the body
Metabolises liver glycogen storage
Once over, can replenish them by administration of longer acting carbohydrates
What are signs of nocturnal hypoglycaemia and how do you prevent it
Waking up tired with headache
Wet from sweating
Avoid triggers like alcohol and more regular blood glucose monitoring
Carry glucose tablets and sweets
How does diabetic ketoacidosis occur
Chronic, uncontrolled hyperglycaemia
Lack of insulin- body is unable to use glucose as energy source, body must use alternative to break down fatty acids
Build up of ketones becomes acidic
What are the common causes of diabetic ketoacidosis
Infections- people stop taking insulin after feeling unwell and lose appetite- people can increase insulin requirement
Newly diagnosed diabetes
Insulin errors
Omissions
Non-compliance
What are the common symptoms and manage of DKA
Thirstiness Frequent urination tiredness Blurry vision Cramp Laboured breathing Unconsciousness Postural hypotension and dehydration
How do you treat diabetic ketoacidosis
Intravenous Rehydration
Insulin infusion
Careful correction of electrolyte balance (K+)
How does hyperglycaemic hyperosmolar state (HHS) occur and reasons behind it
Type 2 diabetic with high blood glucose level- due to both illness and dehydration
Patient may have stopped medication due to illness (nausea or swallowing difficulties)
Usual anti diabetic medication has reduced effects due to body’s response to illness
What are the signs and symptoms of hyperosmolar state (HHS)
Excess urination Nausea and vomiting Thirst Dry skin General weakness
Leg cramps visual impairment Confusion Drowsiness Unconsciousness
What counts as very high blood glucose, low ketone levels in urine, mild acidosis or hyperosmolality
High blood glucose (>30mmol/L)
Low ketone levels (<3mmol/L)
Mild acidosis (pH > 7.3)
Hyperosmolality (>320 milliosmoles/kg)
How do you treat hyperglycaemic hyperosmolar state (HHS)
Rehydration and replacement of electrolytes (IV fluids)
Normalise water electrolyte balance (osmolarity with IV fluids)
Normalise blood glucose levels (low dose insulin IV)
Anti-coagulant prophylaxis (low molecular weight heparins)
Prevention of foot ulceration
How do diabetic foot complications arise
Poorly controlled diabetes from nerve damage and poor circulation
Neuropathy: loss of feeling in feet- may notice cut or injury on food
Skin: dry, cracked or no elasticity- more prone to injury or infection
Poor circulation- wounds are slow to heal and may require amputation
How do you avoid complications affecting feet
Monitor regular sensitivity of food to touch
Look after feet with
soap and dry
nails trimmed
Wear well fitting shoes
Attend annual clinical foot examination
how do diabetic retinopathy occur
Blood vessels supplying the retain become blocked and/or leaky and leads to damage and reduced friction
How do you avoid complications affecting the eye
Annual eye screening
Keep blood glucose to normal limits
Achieve recommended HDL/LDL levels
Maintain blood pressure in normally range
How do you treat diabetic retinopathy
Laser surgery- improves circulation in retina and stops leaky or inappropriate retina growth
Corticosteroid implant- fluocinolone
How does hyperglycaemia cause kidney complcations
Damages the small blood vessels that supply the kidneys
Affects the kidney function (filtration) and leads to neuropathy
What is the treatment for diabetic nephropathy
Managing blood pressure
ACE inhibitors and angiotensin II receptor antagonists- both used to prevent further kidney damage and to control BP
Possible to use ACE inhibitors even if BP is normal as effects are independent of hypotensive action
Diet modification- low salt and limited protein
What are the three types of diabetic neuropathy and describe what they involve
- Sensory Neuropathy:
Lack of feeling in extremities (pain,temperature)
2. Autonomic Neuropathy: Incontinence, erectile dysfunction, irregular heart beat Abnormal sweating (lots or little) Gastroparesis (delayed gastric emptying)
- Motor Neuropathy
Muscle weakness, washing, twitching and cramp
How do you avoid diabetic neuropathy
Annual foot examination
Blood glucose within normal limits
Sensory Neuropathy- avoid situations that lead to injury (bare foot, friction from shoes)
Noticing signs of tingling, numbness, shooting or burning pain, insensitivity to temperature or pain, co-ordination loss
What is the treatment for diabetic neuropathy
Analgesia: Sensory Neuropathy
Slidenafil- erectile dysfunction (autonomic neuropathy)
Antiemetics- nausea and vomiting (gastroperesis)
