Type one diabetes (R1): treating DKA, hyperglycaemia and hypoglycaemia

Question 1

DKA
- Acronym?

Answer 1

SPIDER
- S: saline
- P: potassium
- I: insulin
- D: dextrose
- E: electrolytes
- R: reasons

Question 2

DKA
- 4 principles of management?

Answer 2

Correct volume defecit: saline
Correct potassium levels: potassium replacement
Correct hyperglycaemia: IV insulin + IV dextrose
Fix underlying cause

Question 3

DKA
- Why is potassium replacement important?

Answer 3

Because despite hyperkalaemia, there is a total body potassium defecit; and to prepare for insulin infusion, which will draw potassium into the cells. `

Question 4

DKA
- Why is insulin important?
- Why is dextrose important?

Answer 4

Insulin will bring down BGLs, and draw glucose into cells - so they can switch back to using glucose for fuel instead of ketones.
Dextrose is a type of glucose, as above will switch away from ketones.

Question 5

DKA
- Describe treatment to a patient.

Answer 5

• As you’ve been urinating a lot, you’re loosing a lot of fluid and electrolytes, particularly potassium. We’re going to give you fluids and potassium through a drip in your arm.
• As your body isn’t making insulin, we’ve going to replace that through a drip in your arm. Will help glucose get back into your cells.
• We want to switch your body’s energy source from breaking down fats (and making ketones) back to sugars. So we will give you some sugars through the drip to kickstart this process.

Question 6

How to treat hyperglycaemia (without DKA?)

Answer 6

Question 7

Hypoglycaemia
- Level?
- Causes?

Answer 7

Question 8

Hypoglycaemia
- Symptoms?

Answer 8

SNS: sweating + pallor + tremor
Neurological: seizures + conscious state changes
Chronic: morning headaches, weight gain

Question 9

Hypoglycaemia: treatment
- If alert and oriented?
- If altered mental state?

Answer 9

Alert: oral glucose or fast acting carb (glucose tablets, candy, fruit)
Altered mental status: IV dextrose or if IV not available, IM glucagon