Diabetic emergencies and high glucose states

Question 1

What is DKA?

Answer 1

Diabetic ketoacidosis

A disordered metabolic state that usually occurs in the context of an ABSOLUTE or RELATIVE insulin DEFICIENCY accompanied by and INCREASE in the counter-regulatory hormones i.e. glucagon, adrenaline, cortisol and growth hormone

Question 2

What is HHS?

Answer 2

Hyperglycaemic Hyperosmolar Syndrome

Question 3

What type(s) of diabetes can DKA occur in?
(type 1/type 2)

Answer 3

Type 1 and type 2

Question 4

What triggers stress hormone activation is DKA?

Answer 4

Insulin deficiency (absolute or relative)

Question 5

What effects does the activation of stress hormone in DKA have?
(4)

Answer 5

Increased lipolysis
Increased proteolysis
Increased glycogenolysis

Decreased glucose utilisation

Question 6

What effects does the increased lipolysis that occurs in DKA have?

Answer 6

Increased free fatty acids to liver –> increased ketogenesis –> ACIDOSIS

Question 7

What effects does the increased proteolysis, increased glycogenolysis and decreased glucose utilisation that occurs in DKA have?

Answer 7

HYPERGLYCAEMIA

Hyperglycaemia –> Glycosuria –> electrolyte loss –> dehydration

Dehydration –> increased lactate –> ACIDOSIS
Dehydration –> DECREASED RENAL FUNCTION –> glycosuria
Dehydration –> HYPEROSMOLAR HYPERGLYCAEMIC STATE

Question 8

What (in DKA) leads to HHS?

Answer 8

Dehydration

Dehydration due to:
electrolyte loss (due to glycosuria, due to hyperglycaemia)
osmotic diuresis

Question 9

What is HHS?

Answer 9

HYPEROSMLAR HYPERGLYCAEMIC STATE

Question 10

In DKA, what can decreased renal function cause?

Answer 10

Glycosuria
(vicious cycle)
(glycosuria causes decreased renal function and decreased renal function causes more glycosuria)

Question 11

What is glycosuria?

Answer 11

Glycosuria (or glUcosuria) is the excretion of glucose into the urine.

Question 12

The EURODIAB study found that __% of 3250 insulin - dependent diabetic patients in Europe had been admitted to hospital for DKA one or more times in the previous 12 months.

In Tayside in 2015: ~__% of Type 1 patients were admitted with one or more episodes

Answer 12

The EURODIAB study found that 8.6% of 3250 insulin - dependent diabetic patients in Europe had been admitted to hospital for DKA one or more times in the previous 12 months.

In Tayside in 2015: ~3.7% of Type 1 patients were admitted with one or more episodes

Question 13

Who most commonly has DKA episodes?

Answer 13

20-29 y/o females