Non-Vascular Complications of Diabetes

Question 1

Diabetic Ketoacidosis (DKA) biochemical triad

Answer 1

hyperglycemia, ketonemia, and anion gap metabolic acidosis

Question 2

Hyperosmolar Hyperglycemic State (HHS) Distinguished from DKA by

Answer 2

Severe hyperglycemia >600
Hyperosmolality
Develops more insidiously with polyuria, polydipsia, and weight loss, often persisting for several days before hospital admission
Greater degree of dehydration:
Relative absence of acidosis and ketones
Mortality rates 5-20%

Question 3

DKA and HHS Treatment

Answer 3

Initial assessment:
Airway, breathing, and circulation (ABC) status
Mental status

IV fluid and electrolyte replacement:
Normal saline (0.9% nacl) Slower rate and greater volume for HHS
Insulin replacement starts after rehydration is in progress
Watch potassium levels!!

Insulin therapy:
0.1units/kg/hr

Question 4

Management of Hypoglycemia

Answer 4

Treatment: Glucose
Outside hospital setting
Oral
SQ/IM

Hospital setting
IV
1 amp of D50 (20-50mL)

Question 5

Whipple’s triad

Answer 5

In the patient without diabetes, the definition of hypoglycemia is based upon the presence of Whipple’s triad:

Symptoms & signs consistent with hypoglycemia
a low plasma glucose at the time of symptoms
and resolution of those signs and symptoms after raising the plasma glucose

Question 6

Dawn Phenomenon

Answer 6

High morning blood glucose

Between 5 & 9am:
Counter-regulatory hormones released

Question 7

Somogyi Effect

Answer 7

“hypoglycemia begets hyperglycemia”

Rebound Hyperglycemia—Iatrogenic

Middle of the night:
Lo sugars

Morning:
Hi sugars