Hyperglycaemia Flashcards
What can cause hyperglycaemia?
T1DM
T2DM
GDM
Cushings
Acromegaly
Steroids
Pancreatitis
Post stroke
Post MI
What are the symptoms of hyperglycaemia in Diabetes?
Polydipsia
Polyuria
Blurred vision
Unexplained weight loss
Recurrent infections
Tiredness
What values can be used to diagnose diabetes mellitus?
HBA1C >48
Fasting glucose >7
Random glucose >11.1
IGTT >11.1
If with symptoms - diagnosis
if asymptomatic repeat test
What are the biochemical blood values indicating DKA?
pH <7.3
Plasma Glucose >11mM
Blood ketones >3mM
How does DKA present?
confusion
Kussmaul breathing
abdominal pain
nausea
vomiting
precipitants include infection
surgery
missed insulin doses
trauma
How to manage DKA?
A-E
Fluids
Insulin
What fluids are used to manage DKA?
0.9% saline - dehydration is fatal
If Systolic blood pressure <90 give 500ml in 15 mins (RESUS fluids)
If SBP >90, give 1L over 1 hour
- If K+ is 3.5-5.5 then add KCL to 2nd litres of fluids
How is insulin used in the management of DKA?
Only given after fluids and ensure K+ is not <3.5!!
0.1 u/kg/h insulin fixed rate regimen
What values indicate DKA resolution?
Ketones at <0.6 and pH at >7.3
What is hyperosmolar hyperglycaemic state?
pH >7.3
Osmolarity >320mOsm
Blood glucose >30mM
How does hyperosmolar hyperglycaemic patients present
Acutely unwell with confusion and clinical dehydration
Management of HHS?
Fluid RESUS 0.9% saline / 1 hour
IV insulin IF 1>mmol/L ketones
0.05 u/Kg/hr fixed rate
Monitoring -> serial U+Es and glucose readings
