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Year 4: Endocrine > Diabetic Complications > Flashcards

Diabetic Complications Flashcards

1
Q

DKA is a complication of which type of diabetes

A

Type 1

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2
Q

what can precipitate a DKA

A

Missed insulin doses Infection MI

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3
Q

what is a DKA

A

uncontrolled lipolysis – free fatty acids fatty acids converted to ketone bodies ketone bodies cause a metabolic acidosis

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4
Q

what is Kussmauls breathing

A

hyperventilation seen in DKA

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5
Q

Symptoms of DKA

A

abdo pain thirst nausea + vomiting acetone breath - sweet smelling breath

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6
Q

Signs of DKA

A

hyperglycaemia ketonuria Ketonaemia acidosis sweet acetone breath dehydration tachycardia potassium imbalance

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7
Q

diagnosis of DKA (3 things)

A

hyperglycaemia: glucose >11mmol ketosis: blood ketones >3mmol acidosis: pH <7.35

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8
Q

management of DKA

A

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

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9
Q

max rate potassium can be infused at

A

10mmol per hour

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10
Q

what is important to commence before removing insulin/fluid infusion in treating DKA

A

Patient has commenced normal s/c insulin regime prior to stopping

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11
Q

definition of hypoglycaemia

A

blood glucose below 4mmol/L

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12
Q

symptoms of hypoglycaemia

A

tremor

sweating

dizziness

pallor

irritbility/ anxiety

— can lead to reduced consciousness, coma, death if untreated

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13
Q

treatment of hypoglycaemia

A

oral glucose + complex carb afterwards

IM glucagon

IV glucose (125mls 20%, 250mls 10%)

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14
Q

macrovascular complications

A

coronary artery disease

peripheral vascular disease

stroke / MI

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15
Q

Microvascular complications

A

peripheral neuropathy

retinopathy

nephropathy

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16
Q

diabetes increases risk of what infections

A

UTIs

pneumonia

skin/soft tissue - particularly feet

fungal - particularlly oral/vaginal candiasis

17
Q

Target BP diabetes with

  • no end organ damage
  • end organ damage (mirco/macrovascular complications)
A

no end organ damage = 140/80

end organ damage = 130/80

18
Q

bloating + vomitting in Type 1 diabetic with erratic blood glucose control should make you think of what diagosis ?

A

gastroparesis

  • neuropathy of vagus nerve
19
Q

treatment of gastroparesis

A

pro-kinetic e.g. metaclopramide, domperidone, erythromycin

20
Q

appearance of a neuropathic foot ulcer

A

punched out appearance

on plantar surface

21
Q

foot deformity in diabetes

A

charcot foot

22
Q

appearance of diabetic retinopathy on fundoscopy

A

microaneurysms: small red dots

dot + blot haemorrahages from aneursym rupture

hard exudates: lipid + protein leak from vessels

cotton wool sports: retinal nerve fibre ischaemia

23
Q

hyperosmolar hyperglycaemic state (HHS) is a complications of which type of diabetes

A

Type 2

24
Q

what is HHS usually associated with

A

dehydration

hypernatraemia

25
Q

signs + symptoms of HHS

A

polyuria

polydipsia

profound dehydration

confusion

gross hyperglycaemia

hyperosmolarity

hypernatraemia

26
Q

management of HHS

A

thromboprophylaxis (dalteparin) – high risk of VTE

IV insulin

IV Fluids

27
Q

What drug can worsen diabetic control

A

steroids

28
Q

how should insulin be administered in DKA

A

FIXED rate infusion of 0.1 units/kg/hour

29
Q

what happens to a patients normal insulin regime (long acting + short acting) in a DKA

A

continue long acting insulin

stop short acting insulin

30
Q

what does an unrecoradble blood sugar mean?

A

HYPERGLYCAEMIA

31
Q

1st line for painful neuropathy diabetic foot

A

amitryptilline

duloxetine

gabapentin

pregabalin

32
Q

treatment of high BP in diabetes

A

ACE inhibitor

33
Q

what complication can rapid fluid replacement in DKA cause

A

cerebral oedema

Year 4: Endocrine (15 decks)

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