Diabetic Complications Flashcards
DKA is a complication of which type of diabetes
Type 1
what can precipitate a DKA
Missed insulin doses Infection MI
what is a DKA
uncontrolled lipolysis – free fatty acids fatty acids converted to ketone bodies ketone bodies cause a metabolic acidosis
what is Kussmauls breathing
hyperventilation seen in DKA
Symptoms of DKA
abdo pain thirst nausea + vomiting acetone breath - sweet smelling breath
Signs of DKA
hyperglycaemia ketonuria Ketonaemia acidosis sweet acetone breath dehydration tachycardia potassium imbalance
diagnosis of DKA (3 things)
hyperglycaemia: glucose >11mmol ketosis: blood ketones >3mmol acidosis: pH <7.35
management of DKA
FIG PICK
FLUIDS -IV fluid
INSULIN- 50 units actrapid
GLUCOSE - closely monitor
POTASSIUM - hypokalaemia with insulin, monitor + correct as needed
INFECTION - Treat any underlying cause
CHART - fluid balance chart
KETONES - monitor
max rate potassium can be infused at
10mmol per hour
what is important to commence before removing insulin/fluid infusion in treating DKA
Patient has commenced normal s/c insulin regime prior to stopping
definition of hypoglycaemia
blood glucose below 4mmol/L
symptoms of hypoglycaemia
tremor
sweating
dizziness
pallor
irritbility/ anxiety
— can lead to reduced consciousness, coma, death if untreated
treatment of hypoglycaemia
oral glucose + complex carb afterwards
IM glucagon
IV glucose (125mls 20%, 250mls 10%)
macrovascular complications
coronary artery disease
peripheral vascular disease
stroke / MI
Microvascular complications
peripheral neuropathy
retinopathy
nephropathy
diabetes increases risk of what infections
UTIs
pneumonia
skin/soft tissue - particularly feet
fungal - particularlly oral/vaginal candiasis
Target BP diabetes with
- no end organ damage
- end organ damage (mirco/macrovascular complications)
no end organ damage = 140/80
end organ damage = 130/80
bloating + vomitting in Type 1 diabetic with erratic blood glucose control should make you think of what diagosis ?
gastroparesis
- neuropathy of vagus nerve
treatment of gastroparesis
pro-kinetic e.g. metaclopramide, domperidone, erythromycin
appearance of a neuropathic foot ulcer
punched out appearance
on plantar surface
foot deformity in diabetes
charcot foot
appearance of diabetic retinopathy on fundoscopy
microaneurysms: small red dots
dot + blot haemorrahages from aneursym rupture
hard exudates: lipid + protein leak from vessels
cotton wool sports: retinal nerve fibre ischaemia
hyperosmolar hyperglycaemic state (HHS) is a complications of which type of diabetes
Type 2
what is HHS usually associated with
dehydration
hypernatraemia
signs + symptoms of HHS
polyuria
polydipsia
profound dehydration
confusion
gross hyperglycaemia
hyperosmolarity
hypernatraemia
management of HHS
thromboprophylaxis (dalteparin) – high risk of VTE
IV insulin
IV Fluids
What drug can worsen diabetic control
steroids
how should insulin be administered in DKA
FIXED rate infusion of 0.1 units/kg/hour
what happens to a patients normal insulin regime (long acting + short acting) in a DKA
continue long acting insulin
stop short acting insulin
what does an unrecoradble blood sugar mean?
HYPERGLYCAEMIA
1st line for painful neuropathy diabetic foot
amitryptilline
duloxetine
gabapentin
pregabalin
treatment of high BP in diabetes
ACE inhibitor
what complication can rapid fluid replacement in DKA cause
cerebral oedema
