Diabetic Emergencies Flashcards
Metabolic actions of insulin
- glucose metabolism
- lipid metabolism
- protein metabolism
How does insuline affect insulin metabolism
- inhibition of glycogenolysis and gluconeogenesis
- increased glucose transport into fat and muscle
- stimulation of glycogen synthesis
How does insulin affect lipid metabolism?
- inhibition of lipolysis in fat
- simulation of fatty acid and triacylglycerol synthesis
- increased rate of formation of VLDL
How does insulin affect protein metabolism?
- increased transport of amino acids into muscle, adipose tissue and liver
- increased rate of protein synthesis
- decreased proteolysis in muscle
GLUT-1
All tissues basal glucose uptake
BBB
Erythrocytes
GLUT-2
Renal tubular cells
B-cells
liver (bidirectional)
GLUT-3
major transporter in neurons and placenta
GLUT-4
Striated muscle
Adipose tissue
GLUT-5
Brush border of intestinal cells
Liver
Spermatozoa
Primarily transports fructose
Describe the normal physiologic insulin secretion
- insulin peaks immediately after meals (prandial)
- always a base amount of insulin available (basal)
- constant supply of basal insulin is essential to maintain overall glycemic control
What type of insulin is Actrapid?
Fast-acting insulin
What type of insulin is Humalog?
Biphasic (analog)
What type of insulin is Actraphane?
Biphasic (human)
2 Types of insulin regimens for type 1 diabetics
- basal bolus regimen
- pre-mixed insulin
Role of Glucagon
- causes the liver to convert glycogen into glucose (glycogenolysis)
- stops glycolysis in the liver and promotes gluconeogenesis
Medical uses of glucagon
- hypoglycaemia
- beta-blocker overdose
- anaphylaxis (if on beta-blockers)
- decreased gastrointestinal motility in endoscopy and radiography of GIT
What is Whipple’s triad
- symptoms consistent with hypoglycemia
- low plasma glucose concentration
- relief of those symptoms after the plasma glucose level is raised
Clinical features of mild hypoglycemia
(mainly adrenergic and cholinergic)
- pallor
- sweating
- tachycardia
- palpitations
- hunger
- paraesthesias
Clinical features of moderate hypoglycemia
(mainly neuroglycopenic symptoms)
- inability to concentrate
- confusion
- slurred speech
- irrational behaviour
- slower reaction time
- blurred vision
- somnolence
- extreme fatigue
Clinical features of severe hypoglycemia
- severe impairment of neurologic function
- completely disoriented behaviour
- LOC
- coma
- seizures
How to treat mild hypoglycemia
- fast acting oral carbohydrates (15g)
- or give IV dextrose
How to treat moderate to severe hypoglycemia
- 50ml of 50% dextrose IV bolus after blood drawn, followed by 10% dextrose
- glucagon - 1mg IM/SC (only if sufficient liver glycogen present)
- eat ASAP
How to prevent hypoglycemia
- patient education
- knowing signs and symptoms of hypoglycemia
- take meals on a regular schedule
- carry a source of carbohydrate
- self monitoring of blood glucose
- take regular insulin at least 30 min before eating
Features of diabetic ketoacidosis
- increased serum and urine concentration of ketones
- blood glucose level >13.8, but <40
- blood pH <7.2
- bicarb level <18
- raised anion gap
- serum osmolality <350
Mechanisms of DKA
- neurohormonal abnormalities (insulin deficiency/resistance, elevation of counter-regulatory hormones)
- hyperglycemia
