Endocrinology 7 - Type 1 Diabetes Flashcards
explain the pathophysiology of DKA
no insulin produced or injected, thus no potassium or glucose uptake into cells
ketosis occurs in response
leads to metabolic acidosis
high blood sugar leads to dehydration via polyuria
hyperkalaemia with low total body potassium
5 key aspects of DKA presentation
hyperglycaemia dehydration ketosis metabolic acidosis potassium derangement
7 key symptoms of DKA
polyuria polydipsia nausea + vomiting acetone breath smell dehydration +/- low BP altered conscious level evidence of trigger (e.g. sepsis)
3 diagnostic criteria for DKA
blood glucose > 11
pH < 7.30
ketones > 3
7 key aspects of DKA treatment
always follow local guidelines
Fluids - 1 litre stat, then 4 litres over 12 hours with added potassium in bags
Insulin - 0.1U/kg/hr Actrapid infusion
Glucose monitoring (infuse dextrose if <14)
Potassium monitoring 4 hourly + correction
Infection - treat any seen
Chart fluid balance
Ketones - monitor +/- gas
4 aspects of patient education for type 1 diabetes
subcut insulin regimes
monitoring carb intake
monitoring sugar levels on waking, at meals, pre bed
monitoring + managing complications
what is a typical insulin regime
long acting insulin once daily in the morning
short acting injected 30 mins pre meals
avoid lipodystrophy by cycling injection locations
give 4 macrovascular complications of diabetes
coronary disease
stroke
peripheral vascular disease + poor healing / ulcers
hypertension
give 3 microvascular complications of diabetes
peripheral neuropathy
retinopathy
nephropathy (glomerulosclerosis)
4 commonest infection complications with diabetes
UTI
pneumonia
skin / foot infections
fungal infections (oral/vaginal common)
what regular monitoring should people with type 1 diabetes have?
3-6 monthly HbA1c check
urine alb:creatinine ratio screen yearly
regular eye screening
optimise cardiac risk factors using QRISK
