Week 6: Diabetic Emergencies

Question 1

What is insulin?

Answer 1

Facilitates the movement of glucose into cells (muscle and adipose)
Stimulates storage of glucose, amino acids ad fatty acids
Stimulates glycogen formation and storage in the liver

Question 2

What is glucagon?

Answer 2

Secreted in response to low BGL, increased catecholamines and sympathetic nervous activation
Raises BGL by stimulating glycogenolysis

Question 3

What is glycogenolysis?

Answer 3

Conversion of glycogen to glucose

Question 4

What is type 1 diabetes?

Answer 4

Immune mediated disease caused by destruction of pancreatic beta cells
Pancreas does not produce insulin

Question 5

What is type 2 diabetes?

Answer 5

Pancreas continues to produce some insulin but it is insufficient to the person’s needs

Question 6

What is hypoglycaemia?

Answer 6

BGL less than 4 mmol/L (or rapid reduction in BGL)
Release of counter-regulatory hormones
Activation of ANS
Glucagon and adrenaline released

Question 7

What are the early signs of hypoglycaemia?

Answer 7

Sweating
Shaking
Dizziness
Hunger
Tingling around mouth
Palpitations
Headache

Question 8

What are the late signs of hypoglycaemia?

Answer 8

Double vision
Unusual behaviour
Confusion
Drowsiness
Unconsciousness

Question 9

What is the management of hypoglycaemia?

Answer 9

Quick acting carbohydrate if conscious

Decreased LOC: SC or IMI glucagon, or IV glucose

Question 10

What is DKA?

Answer 10

Results from severe insulin deficiency that leads to disordered metabolism of proteins, carbohydrates and fats

Question 11

What are the manifestations of DKA?

Answer 11

Severe hyperglycaemia
Ketosis, metabolic acidosis
Dehydration, fluid and electrolyte imbalance

Question 12

What are the causes of DKA?

Answer 12

Infection
Severe illness
MI
Initial presentation of type 1 diabetes
Discontinuation of insulin therapy

Question 13

How does DKA cause hyerglycaemia and hyperosmolality?

Answer 13

Insulin deficiency –> decreased glucose uptake in cells, more remaining in blood plasma
Excessive gluconeogenesis and glycogenolysis –> raised BGL
Counter regulatory hormones (cortisol and catecholamines) –> raised BGL
Glycosuria (caused by exceeding renal threshold of 10 mmol/L –> causes water depletion by osmotic duiresis

Question 14

How does DKA cause hypovolaemia?

Answer 14

Hyperglycaemia and hyperosmolality –> draws water out of cells by osmosis, causing interstitial and intracellular dehydration
Osmotic duiresis

Question 15

What are the complications of hypovolaemia?

Answer 15

Hypovolaemia –> decreased tissue perfusion –> lactic acidosis from anaerobic metabolic
Hypovolaemic shock
Loss of ECF –> decreased GFR –> increased urea and creatinine

Question 16

What are the signs of hypovolaemia?

Answer 16

Low BP
Increased HR
Decreased LOC
Cool, pale peripheries

Question 17

How does DKA cause electrolyte depletion?

Answer 17

Osmotic diuresis

Question 18

What to potassium concentration occur in DKA and why?

Answer 18

Variable, however still net loss of potassium

Low:
Losses in urine
Haemodilution

High:
Hyperosmolality causes shift form intra to extra cellular space
Displaced by hydrogen ions and forced into plasma