complications Flashcards
Why would you get dehydration in DM?
What’s the difference in terms of onset of T1DM and T2DM?
Due to osmotic diuresis
T1DM - relatively sudden
T2DM - slow progression
What are 3 main acute complications that can arise from DM? Which ones tend to happen in which DM?
acute:
- hypoglycaemia
- diabetic ketoacidosis (hyperglycaemia T1DM)
- hyperosmolar hyperglycaemic state (T2DM)
Below what blood glucose level does symptoms of hypoglycaemia present?
<4mmol/L
Explain some causes of hypoglycaemia in either types of DM
Explain some of the symptoms seen in hypoglycaemia
T1DM - insulin overdose, excessive exercise, inadequate CHO intake
T2DM - sulphonylureas (elderly), hepatic/renal disease, drugs
Symptoms:
palpitations, tremors, sweating, anxiety (counter-regulartory activity of SNS)
loss of conc, slurred speech, behaviour/mood changes, seizures (glucose deficiency in brain)
Treatment for hypoglycaemia? (conscious and unconscious)
conscious - sugary drink/food, then sustained carb snack
unconscious - glucose or glucagon i.v/i.m
glucagon can’t be used after alcohol
What is diabetic ketoacidosis?
diabetic coma - hyperglycaemia and metabolic acidosis
What’s insulin’s normal function on adipose tissue, SKM, and liver?
adipose tissue- increase glucose uptake (GLUT-4), lipogenesis, decr in lipolysis
SKM - increase glucose uptake and protein synthesis, decr protein breakdown
liver - increase glycogen synthesis, decr glycogen breakdown and gluconeogenesis
What are the 4 processes that happen if you loose the insulin signal? (In liver, adipose and muscle tissue)
liver - gluconeogenesis and glycogen breakdown
adipose - lipolysis
SKM - protein breakdown
Explain the process by which you get hyperglycaemia and ketosis during uncontrolled T1DM
all intermediates/products bc of processes feed into liver to feed ketogenesis and cause hyperglycaemia The FFAs (from lipolysis) go through beta-oxidation and go through ketogenesis, forming acetoneacetate, beta-hydroxybutyrate and acetate
Clinical signs and symptoms of hyperglycaemia and ketosis?
hyperglycaemia: peripheral circulatory failure, renal failure, low cerebral blood flow
metabolic acidosis - CNS depression and diabetic coma
More severe consequences of hyperglycaemia and ketosis?
DEATH
What’s the treatment for diabetic ketoacidosis?
- insulin i.v (supress ketogenesis, reduce blood glucose, correct electrolyte imbalance)
- replacement of fluids, electrolytes
- treat underlying cause
What is HHS? What’s the blood glucose level for it?
hyperosmolar hyperglycaemic state
v high blood glucose >40 mmol/L
severe hyperglycaemia without ketosis
What are 3 tests done to monitor glucose control?
What’s the recommended range for HBA1C?
urine testing - ketones and glucose
blood glucose testing
HbA1C test (recommended range 48-59 mmol/mol)
What are some long-term complications of DM? (think in terms of micro and macrovascular)
microvascular: retinopathy, nephropathy, neuropathy
macrovascular: CVD, cerebral vascular disease (stroke), peripheral vascular disease.
