Hyperglycaemia complications of diabeteds

Question 1

What is DKA?

Answer 1

Diabetic Ketoacidosis

Hyper blood glucose in combination with presence of ketones causing metabolic acidosis

Question 2

What are the causes of DKA?

Answer 2

Infection
Alcohol intoxication
Undiagnosed DM
Non adherence to treatment
Previous surgery or trauma

Question 3

What are the symptoms of DKA?

Answer 3

Polyuria
Polydipsia
N&V
Abdo pain
Confusion
Drowsiness 
Coma
Acetone breath
Hyperventilation

Question 4

How is DKA diagnosed?

Answer 4

Glucose >11.1mmol/L or known diabetes
Capillary ketones >3 or ++ on urine dip
pH <7.3 or bicarb <15

Question 5

What other investigations are needed in DKA?

Answer 5

To underlying cause
FBC
CRP
U&Es
LFTs
CXR
Cultures

Question 6

What is the management of DKA?

Answer 6

Fluid resus- 0.9% Saline 
-SBP >90= 1L
-SBP <90=500ml stat
IV insulin- 0.1units/kg/hr
IV potassium replacement- if K+ 3.5-5.5

Once glucose <15 then add 5% dextrose to saline
Monitor glucose and ketones regularly
Fluid balance chart

Question 7

What is the pathophysiology of DKA?

Answer 7

High blood glucose with lack of insulin leads to cells believing they are being starved
Triggers liver to produce more glucose and lipolysis and ketone formation to occur
Ketones lead to metabolic acidosis and hyperventilation
Excess blood glucose draws water out of the cells and causes cells to become dehydrated
Decreased resorption of glucose in kidneys leads to increased excretion in the urine

Question 8

What is HHS?

Answer 8

Hyperglycaemic Hyperosmolar State

High blood glucose with increased serum osmolality without evidence of ketosis

Question 9

What are the causes of HHS?

Answer 9

G6 rich foods e.g. fava beans
Infection
Drugs e.g. thiazides and steroids
MI

Question 10

What is the pathophysiology of HHS?

Answer 10

Increased blood glucose levels causes water to be drawn out of cells causing an increase in circulating osmolality

Onsets over a few days

Question 11

How is HHS diagnosed?

Answer 11

Hypovolaemia

Glucose >30mmol/L

Osmolality >320 (2xNa + Urea +glucose)

Question 12

What other investigations are needed in HHS?

Answer 12

U&Es
FBC
CRP
Cultures
Look for underlying cause
Ketones must be <3

Question 13

What is the management of HHS?

Answer 13

IV fluid resus

Replace K+
Prophylactic LMWH
Senior help
Normally treated in HDU