Diabetic Emergencies

Question 1

what is hypoglycaemia

Answer 1

low blood glucose

Question 1

what is the most common side effect of insulin therapy

Answer 1

hypoglycaemia

Question 2

when does hypoglycaemia occur

Answer 2

more insulin injected than is needed
irregular eating habits, unusual exertion and alcohol excess

Question 3

what times are you at greatest risk of hypoglycaemia

Answer 3

before meals, during the night or during or after exercise

Question 4

what is the greatest diabetic-related risk of hypoglycaemia

Answer 4

prior episode of severe hypoglycaemia

Question 5

who is the most at risk for severe hypoglycaemia

Answer 5

young people. low socioeconomic status, comorbidity, use of anti-depressants, people with fear of hyperglycaemia

Question 6

clinical presentation of hypoglycaemia

Answer 6

pallor, sweating, tremor, palpitations, confusion, nausea, hunger

Question 7

how is hypoglycaemia classified

Answer 7

level 1-3

Question 8

level 1 hypoglycaemia

Answer 8

glucose alert level of 3.9 or less

Question 9

level 2 hypoglycaemia

Answer 9

glucose level <3

Question 10

level 3 hypoglycaemia

Answer 10

severe, cognitive impairment, requires external assistance for recovery

Question 11

management of severe hypoglycaemia

Answer 11

IM glucagon or IV glucose

Question 12

management of hypoglycaemia

Answer 12

15-20g oral glucose

Question 13

what is DKA

Answer 13

diabetic ketoacidosis

Question 14

what type of diabetes is commonly associated with DKA

Answer 14

T1DM

Question 15

what are the 2 general causes of DKA

Answer 15

insulin deficiency
increased insulin demand

Question 16

5 I causes of increased insulin demand

Answer 16

infections, inflammation, intoxication, infarction or iatrogenic

Question 17

where are ketone bodies formed

Answer 17

in liver mitochondria

Question 18

what are ketone bodies formed from

Answer 18

acetyl-CoA

Question 19

why is insulin needed to prevent the formation of ketone bodies

Answer 19

inhibits lipolysis

Question 20

pathophysiology of DKA

Answer 20

lack of insulin means the amount of glucose taken up from the blood into tissues and amount of glycolysis will reduce, so body switches to fatty acid oxidation

Question 21

consequences of accumulation of ketone bodies

Answer 21

acidosis
high glucose excretion causes osmotic diuresis, causing electrolyte loss and dehydration -> decreases renal function and exacerbates acidosis

Question 22

osmotic related symptoms of DKA

Answer 22

thirst and polyuria
dehydration

Question 23

ketone body related symptoms of DKA

Answer 23

vomiting
flushing
abdominal pain and tenderness
increased resp rate
pear drop smell on breath

Question 24

resp sign associated with DKA

Answer 24

kussmaul's respiration

Question 25

what is kussmaul's respiration

Answer 25

deep, rapid breathing pattern (hyperventilation)

Question 26

diagnosis of DKA

Answer 26

hyperglycaemia with ketonemia or heavy ketonuria and acidosis

Question 27

investigations which show acidosis in DKA

Answer 27

bicarbonate < 18, venous pH <7.3

Question 28

other biochemistry signs of DKA

Answer 28

hypokalaemia creatinine raised sodium low amylase raised white cell count raised

Question 29

management of DKA

Answer 29

fluid replacement replace electrolytes restore acid-base balance (usually compensated on its own fairly quickly) insulin replacement MONITORING

Question 30

name 3 complications of DKA

Answer 30

cerebral oedema aspiration pneumonia ARDS

Question 31

what is hyperglycaemic hyperosmolar syndrome commonly associated with

Answer 31

T2DM

Question 32

what is hyperglycaemic hyperosmolar syndrome

Answer 32

severe hyperglycaemia without significant ketosis

Question 33

when do people present with hyperglycaemic hyperosmolar syndrome

Answer 33

middle age with previously undiagnosed diabetes

Question 34

state 3 common precipitants of hyperglycaemic hyperosmolar syndrome

Answer 34

consumption of glucose rich foods, concurrent medications (thiazide, steroids) and intercurrent illness

Question 35

what causes hyperglycaemic hyperosmolar syndrome to differ from DKA

Answer 35

small amounts of insulin is secreted by the pancreas

Question 36

clinical presentation of hyperglycaemic hyperosmolar syndrome

Answer 36

dehydration due to polyuria polydipsia N+V stupor/coma

Question 37

what is stupor

Answer 37

decreased level of consciousness

Question 38

how is hyperglycaemic hyperosmolar syndrome diagnosed

Answer 38

profound hyperglycaemia hyperosmolarity volume depletion in the absence of ketoacidosis

Question 39

management of hyperglycaemic hyperosmolar syndrome

Answer 39

fluid replacement without insulin only start insulin if significant ketones

Question 40

what is alcoholic ketoacidosis

Answer 40

increased production of ketones with normal or low glucose as a result of excess alcohol and starvation

Question 41

who usually gets alcoholic ketoacidosis

Answer 41

malnourished individuals with AUD

Question 42

what is associated with alcoholic ketoacidosis

Answer 42

recent episodes of binge drinking complicated by poor food intake, dehydration and vomiting

Question 43

clinical presentation of alcoholic ketoacidosis

Answer 43

N+V abdo pain increased resp rate dehydration

Question 44

management of alcoholic ketoacidosis

Answer 44

IV pabrinex (high dose vitamins including thiamine) IV fluid, anti-emetics insulin if required