T2DM + HHS (in addition to quizlet cards)

Question 1

what is the normal HbA1c?

Answer 1

<42 mmol

Question 2

what is pre diabetes

Answer 2

hba1c 42-48 mmol

Question 3

dx of diabetes

Answer 3

aysymptomatic: hba1c >=48 measured twice
symptomatic: only need one >=48

Question 4

2h glucose tolerance test (not actually used for dx anymore but still good to know as can sometimes be referred to)

Answer 4

<7.8 = normal

7. 8-11.1 = impaired g tolerance
8. 1 = diabetes

Question 5

fasting glucose (cannot eat or drink 8-10 h before test)

Answer 5

<6.1 = normal
6.1-7 = impaired fasting glucose
>=7 = diabetes

Question 6

presentation of t2dm

Answer 6

polyuria, polydipsia
weight loss
fatigue
irritability
hyperosmolar hyperglycaemic state
increase appetite
blurred vision
slow healing sores
infections
diabetic nerphroapthy
diabetic foot
leg ulcers

Question 7

what is a hyperosmolar hyperglycaemic state

Answer 7

severe hyperglyc as a result of illness/dehydration/inability to take meds

hyperosmolarity = v concentrated

Question 8

why does ketosis not occur in HHS

Answer 8

presence of basal insulin sufficient to prevent ketogenesis but insufficient to reduce blood gluc

Question 9

what does HHS result in

Answer 9

hyperglyc -> polyuria

hyperosmolarity -> water into intravascular compartment -> severe intracellular dehydration

Question 10

hypervolaemia or hypovolaemia? in HSS

Answer 10

hypo due to diuresis (peeing)

Question 11

causes of HHS

Answer 11

• intercurrent illness (MI, infection, stroke, anything)
• meds (diuretics, bb, CCBs, pred, so many)
• poor diabetic control

Question 12

presentation HHS

Answer 12

extremely ill patient
usually elderly with many comorbidities
often come in sick e.g. stroke, MI, sepsis, IECOPD, long lie
signs of gross dehydration
focal/global neuro dysfunction (easily confused with stroke)

generally weak, leg cramps, vision impairment
N+V occur much less than in DKA
seizures 25%

Question 13

ix HHS

Answer 13

urinalysis: marked glycosuria, normal/slightly raised ketones
- BM
- serum osmolarity
- U+Es -> dehydration, AKI, Na and K deranged
- FBC, CRP, blood/urine culture -> infection
- ABG
- further Ix for underlying cause

Question 14

what will ABG show in HHS

Answer 14

met acidosis, usually >7.3

Question 15

main aims of HHS rx

Answer 15

treat cause
graudally+safely normalise osmolality
repalce fluid and electrolyte losses
normalise blood glucose

Question 16

how to calculate osmolality

Answer 16

2(Na+K)+ gluc + urea

Question 17

initial rx HHS

Answer 17

ABCDE

Question 18

fluid rx

Answer 18

LOADS of fluid is given. pts are extremely dehydrated.

IV 0.9% saline
1 L over 1st hr. more rapid if SBP < 90
1 L each hr for next 6 hrs

must have catheter in to monitor fluid balance

Question 19

what is a positive fluid balance

Answer 19

intake of fluids greater than output

Question 20

aim for what positive fluid balance

Answer 20

2-3 L by 6 h

Question 21

complications of rx

Answer 21

fluid overload, cerebral oedema, central pontine myelinosis ASSESS FOR THESE EVERY 1-2 h (indicated by deteriorating conscious level
NB CPM usually occurs when correctting hyponatraemia, cerebral oedema occurs from pushing fluids too quickly

Question 22

NB HHS has higher mortality than DKA

Answer 22

15-20% (5% for DKA)

Question 23

complications of HSS

Answer 23

MI, stroke, peripheral artery thrombosis, DVT, DIC, multi organ failure

Question 24

values to diagnose HHS

Answer 24

glucose >30!!! vvvv high. can be 50-60
ketones <3
serum osmolality >320

Question 25

HHS pts at high risk of…

Answer 25

VTE. need dalteparin

Question 26

how much insulin? rate?

Answer 26

FIXED RATE INSULIN INFUSION
ketones <1 = no insulin
ketones >1 0.05 units / kg / hr

Question 27

when is insulin given?

Answer 27

ketonuria >1 or 2+ on dip

Question 28

potassium replacement

Answer 28

same as DKA

none if >5.5, 40mmol over 2 hr if 3.5-5.5, senior review if <3.5