Diabetes Presentation Flashcards
What are the main symptoms of diabetes? [8]
- Thirst
- Polyuria/Nocturia
- Weight loss
- Tiredness
- Blurred vision
- Abdominal pain
- Frequent low grade infections e.g. thrush
- Slow wound healing
Explaint the symptoms of diabetes?
- Polyuria and thirst
- Weight loss
- Tiredness
- Blurred vision
- Infections
- Slow wound healing
Polyuria and thirst - Body clearing a lot of glucose through the kidneys
Weight loss - Can’t Take up and use glucose or amino acids
Tiredness - Can’t get energy from glucose
Blurred vision - Glc build up in eye
Infections - High glucose in blood and urine allows bacteria/fungi to grow
Slow wound healing - high glucose in blood enables microorganisms to grow and slow healing
Whats different about Type 1 and type 2 presentation? [3]
Age of onset:
- Type 1 is generally in kids or adolescents
- Type 2 is usually adult
Type 2 patients are generally overweight
Type 2 is rarely ketotic
What would you look for in possibly diabetic children?
4Ts!
- Thirsty
- Tired
- Thinner
- Toileting more
Returns to day or bed wetting in a dry child are a red flag of diabetes
How would you assess for diabetes in kids under 5?
Heavier/wetter nappies blurred vision Candidiasis (oral or vulval) Constipation Recurrent skin infections Irritability or behavioural changes
At what point in childhood does diabetes present?
At any point but mostly in adolescence
Why is it so important to diagnose diabetes as quickly as possible? [1]
Undiagnosed children can very easily go into Diabetic Ketoacidosis -> Coma -> Death
How does uncontrolled diabetes present in the short term? [7]
Thirst (polydipsia) Tiredness Polyuria/nocturia Weight loss Blurred Vision Abdominal pain Dehydration
What are 3 acute and life-threatening problems that diabetes can present with?
Acute metabolic upset in the form of hypoglycemia
Diabetic Ketoacidosis (DKA)
Hyperosmolar Hyperglycaemia State (HHS)
Diabetic Ketoacidosis
Pathogenesis [3]
Signs [6]
Low levels of insulin > lipolysis > release of fatty acids
FAs are converted to Ketone bodies in the liver as source of glucose
Ketone bodies causes acidosis
Signs
- Dry mucus membranes
- Ketotic breath
- Tachycardia, hypotension
- Kussmaul respiration
- Weakness, confusion (altered mental state) -> Coma
- Hypothermia
Define Hyperosmolar Hyperglycaemic State [3]
Symptoms [5]
High blood sugar levels [1] resulting in a high osmolarity [1] of blood without significant ketoacidosis [1]
More common in Type 2, it leads to:
- Dehydration
- Weakness
- Leg cramps
- Visual problems
- Altered Consciousness
Hypoglycemia is one of the ways that diabetics can present acutely i.e. ‘acute metabolic upset’
Define hypoglycemia [1]
Sequelae if untreated [5]
Causes [6]
Any episode of low blood glucose <4mmol/l with or without symptoms
- Cognitive Dysfunction
- Lethargy
- Coma
- Convulsions
- Death
Causes
- Too much insulin or SU
- Inappropriate timing of insulin or SU
- Injection site problems
- Inadequate food intake
- Exercise
- Alcohol
Pathogenesis DKA [2]
Causes or precipitants [4]
Low levels of insulin allow glucagon to rise [1] , causing FAs to be released from adipose and broken down for energy [1]
Period of extra energy need can trigger DKA such as stress, infection or insulin omission
DKA itself has complications, what are they? [6]
Hyper/hypokalemia Cerebral oedema (the cause of confusion, coma and death) Aspiration & pneumonia Thromboembolism ARDS Hypoglycemia
