Endocrine - Online MedEd - Diabetic emergencies Flashcards
One episode of hypoglycaemia can be deadly!
Diabetic and hypoglycaemia - usual cause?
Doctors might - too much insulin/too much meds
Patient might - exercise too much, eating too little, sepsis
Diabetic and hypoglycaemia - what to do?
Give oral glucose load
Candy, juice, non-diet soda - something with rapid acting glucose
If patient is in COMA –> cannot take oral, give IV
*This is an emergency
Patient will know if hypoglycaemic - symptoms?
Palipitations
Diaphoresis
Presyncope
Progress to coma
Diagnosis of hypoglycemia
Check glucose
Causes of hypoglycemia
Less medicine?
Exercise carry snacks
Need to figure out why got hypoglycaemia*
If patient normally has high sugars… they might experience hypoglycaemic symptoms at high glucose values - what to do?
Treat if there are the symptoms
What happens if hypoglycaemic and not diabetic? true hypoglycaemia with symptoms… 2 causes:
1) Insulinoma
2) Factitious
3) Abs
Insulinoma - tests to do
Wait for hypoglycemic: Low glucose C peptide - ELEVATED Pro-insulin Secretagogue screen
Pro-insulin is packaged with C peptide and where is insulin?
Insulin part of pro-insulin
- In insulinoma, if there is too much pro-insulin there will be too much insulin + c peptide *coming from body
- This is endogenous production
- But still might be giving too much medication, recall that oral sulfonyureas induce insulin production
- So do secretagogue screen!
- So if sulfonylurea screen is positive –> they are ingesting! tell them to stop
- If sulfonylurea screen is negative –> consider insulinoma
Factitious cause of hypoglycaemia - lab values
Low glucose
Low C peptide
High insulin
Tx: tell them to stop injecting
Insulinoma - definitive dx
This is after C peptide is high and secretagogue test is negative Do a 72 hour fast and do process again wait for hypoglycemic -Once confirmed, get CT/MRI abdomen
DKA - pathology
Disease that Type 1 get
Type 2 can go to DKA - HHS more common
-Lots of sugar in blood but no insulin
-So body thinks it is starving –> produce ketones –> ketoacidosis
-Intact kidneys –> glucose into urine –> massive osmotic diuresis = profound dehydration
DKA - presentation
Diabetic coma
Ketones
Acidosis
Dx of DKA
Blood glucose Urine ketones+ Might check serum ketones (better answer, but takes longer) Get ABG - acidosis Also need: anion gap and K
Treatment of DKA
Follow DKA protocol
What to look for: watch Glucose, Potassium, Anion Gap
-Glucose - need insulin, 10 units IV insulin with insulin drip
-Recall glucose/insulin shift of K into cells –> give KCl IV (replace K)
-Gap is fixed by insulin!
-Bolus, vigorous hydration NS/lactated Ringer’s
-Glucose might be normal, but gap is still open
-Insulin needs to be continued until gap closes
-As glucose starts to fall, but gap remains open –> start D5/give sugar
-Once gap is closed –> bridge to long acting SubQ insulin and get them off the drip
-If gap reopens, start over
