Diabetic complications and management

Question 1

Symptoms of hypo

Answer 1

Shaking, palpitation, sweating, hunger, confusion, slurring of speech, convulsions

Question 2

Management of hypo

Answer 2

Glucose 10-20g
e.g. sugar lumps, 110ml of lucozade, coca cola

Glucagon 1mg (IM/SC) - if hypo causes unconsciousness (pregnant women can carry a hypokit)

Question 3

Complications

Answer 3

CVD risk, smoking, hypertension, obesity, hyperlipidaemia

CV risks in diabetic patients - reduce by ACEi (nephroprotective)

Question 4

Diabetic neuropathy (pain)

Answer 4

Paracetamol or NSAID

Duloxetine, ami/nortriptyline = alternatives (unlicensed)

Gabapentin

Opioid analgesics e.g. tramadol/morphine

Capsaicin cream - intense burning sensation

Question 5

Diabetic nephropathy (kidney)

Answer 5

Test for urinary protein, serum creatinine
If negative - test for microalbuminuria

If positive - give ACEi or ARB if not C/I

Question 6

Signs and symptoms of DKA

Answer 6

Rapid weight loss
N+V
Ab pain
Sweet smell to breath/metallic taste
Fatigue
Dehydration

Question 7

Management of DKA

Answer 7

Summary: fluid + electrolytes + insulin

NaCl or KCl 0.9% infusion + soluble insulin

Question 8

Pregnancy and breast-feeding

Answer 8

Give folic acid 5mg
HbA1c <48mmol/mol

Safe to use:
Metformin
Glibenclamide (LA) - 2nd and 3rd trimester
Insulin: RA/LA* are safe
Isophane is a good choice *Detemir/Glargine (only if prev on)

Question 9

Diabetes during pregnancy

Answer 9

Insulin requirements increase, during 2nd and 3rd trimester

Discontinue ACEi/ARB (give labetalol or methyldopa)
Discontinue Statin