Diabetic

Question 1

Diabetes

Answer 1

Metabolic disorder, chronic high blood sugar
Major cause of morbidity, premature death due to complications such as heart attack, Stoke, kidney failure and blindness.

Question 2

Blood sugar

Answer 2

3.0 to 5.6 mmol/l
Best 4.00 - 8.00

Question 3

two main types of diabetic emergency

Answer 3

1. hypoglycaemia
2. severe hyperglycaemia,
   a) diabetic ketoacidosis (DKA)
   b) hyperosmmolar hyperglycaemic state (HHS)

Question 4

types of diabets

Answer 4

Type 1 insulin dependent diabets (IDDM)
Type 2 non - insulin dependent diabets (NIDDM)

Question 5

Type 1 diabetes

Answer 5

IDDM . Diabetes are unable to produce any insulin,
usually due to autoimmune disease which destroys the insuliln - producing beta cells in the pancreas.

Question 6

Insulin

Answer 6

produced by beta cells in pancreas.
Hormone that increases transport of glucose across cell membranes .
It targets the muscle, fat, and liver cells to promote the creation of glucose.

Question 7

Type 2

Answer 7

Non insulin dependent diabets (NIDDM)
Patient wiht type 2 diabets have a relative insulin deficiency due to varying degrees of insulin resistance.

Question 8

Causes / risk of diabets

Answer 8

Genetic (Type 1) or other autoimmune disease as a higher risk of developing type 1,
Obesity: body mass index over 25kg/m2 or large waist
Age : people are living longer and beta cell function declines with age, leading to a chance of developing diabets in old age.
Ethinicity: Sough Asian and Afro-Caribbean orgin

Question 9

Hypoglycaemia signs and symptoms

Answer 9

-sweating
- palpitation
- shaking
- hunger
- confusion
- drowsiness
- odd/ aggressive behaviour
- speach problems,
- headache
- nausea

Question 10

Hypoglycaemia management

Answer 10

10-20 g of glucose, choice of: ( and repeat every 10-15 minutes) , 55 ml Lucozade energy orginal, 100 ml coca cola, 18 ml Ribena blackcurrant diluted to taste, 2 teaspoon of sugar, 3 sugar lumps, Glucogel, dextrogel an hypo-fit.
- unable to take oral glucose, administer: IM glucagon (1 mg) or IC glucose .
Glucose should be administer via wide-bore cannula.

Question 11

DKA - severe hyperglycaemia - hyperglycaemic crisis

Answer 11

DKA - is a complex metaboic state characterised by:
1. hyperglycaemia
2. acidosis
3. ketonaemia

Potentially life - threatening complicationof T1DM and T2DM

Question 12

HHS

Answer 12

Hyperosmolar hyperglycaemia state;
- hypovolaemia (secondary severe dehydration)
- blood sugar > 30 mmol/l withouth signs of hyerketonaemia or acidosis
- blood osmolality > 320 mOsmol/kg (not measured out of hospital )

Question 13

DKA and HHS

Answer 13

DKA most commonly occurs in T1DM,
HHS is almost exclusively seen in T2DM and in elderly

DKA presents within hours to days of onset
HHS not which explains why the metaolic derangement and dehyration is more severe.

Question 14

DKA and HHS signs and symptoms

Answer 14

Hyperglycaemia, polyuria, polydipsia, blurred vision, fatigue, weakness, weight loss, vomiting and abdominal pain (DKA) , fruity breath odour (DKA), Kussmaul breathing (DKA), focal neurological signs such as hemiparesis (HHS) ,
- alterned mental state (from confusion to coma) ,
- signs of dehydration : dry mucuous membranmes, poor skin turgor, long furrows on tongue.

Question 15

DKA , HHS management

Answer 15

Focus on prompt recognition and transport to ED ,
Definitive care while managing ABCD
Blood sugar measurement ( asprin, paracetamol, vit C can raise blood glucose, also this may not be clinically siginificant)