Acute Complication of DM, insulin deficiency; Hypoglycaemia;DKA , Hyperosmolar Hyperglycaemia Non-Ketoic Coma

Question 1

What sort of factors can lead to fluctuations in serum glucose levels and subsequent changes in cell metabolism thought the body?

Answer 1

variations in diet/physical activity
presence of infections
alcohol use

complications may be acute (hypoglycaemia) or chronic

Question 2

Two acute complications of DM:

Answer 2

hypoglycaemia
DKA

Question 3

Pathophysiology; Hypoglycaemia:

Answer 3

precipitated excess of insulin = deficit glucose blood
usually occur TI, quite suddenly, following strenuous exercise, error in dosage, vomiting/skipping meal after taking insulin

many individuals recognise own response
lack glucose quickly effects nervous system, -
neurons cannot use fats/protein as energy source

Question 4

SnS; Hypoglycaemia:
related to impaired neurofunction from lack of glucose

Answer 4

poor concentration
slurred speech
lack coordiantion and staggering gait; sometimes assumed to be intoxicated

Question 5

SnS; Hypoglycaemia:
related to hypoglycaemic state stimulating SNS

Answer 5

^pulse
pale, moist skin,
anxiety
tremors

Question 6

SnS; Hypoglycaemia: if hypoglycaemia remains untreated

Answer 6

LOC
seizures, and death will follow

Question 7

Tx; Hypoglycaemia:

can be life threatening if not treated promptly

Answer 7

immediate administration CONCENTRATED CARBOHYDRATE
sweetened fruit juice, candy,

if persons unconscious, glucose, glucagon, may be given parenterally (usually IV)

Question 8

What does DKA result from?

Answer 8

insufficient insulin = high blood glucose and mobilisation of lipids
more common TI

Question 9

Pathophysiology; DKA:

Answer 9

ketoacidosis develops over a few days
may be initiated by infection or stress =
^demand for insulin in body

may also result error dosage or overindulgence in food or alcohol

Question 10

SnS; DKA:
related dehydration, metabolic acidosis, electrolyte imbalances

Answer 10

Thirst
Dry rough oral mucossa
Warm, dry skin
Pulse rapid but weak and thready
Low BP as vascular volume decreases
Oliguria (decreased urine output) indicates compensation mechanism to conserve fluid intake

Question 11

Ketoacidosis leads to the following:

Answer 11

Rapid, deep reps(kussmall reps)
Acetone breath ( sweet, fruity smell)
Lethargy decreased responsiveness indicates depression CN owning to acidosis and decreased blood flow

Question 12

Metabolic acidosis develops as ketoacids bond w bicarbonate ions in the buffer = what reactions?

Answer 12

decreased bicarbonate levels and decreased serum pH
as dehydration progresses, renal compensation decreases, acidosis becomes decompensated
decreased serum pH
LOC

Question 13

Electrolyte imbalance inc. Na+, K+,Cl- and has what following signs?

Answer 13

abdo cramps
nausea and vomiting
lethargy and weakness

Question 14

If DKA remains untreated…

Answer 14

CNS depression develops owning to acidosis and dehydration = coma

Question 15

Tx;DKA:

Answer 15

admin insulin
replacement fluid and electrolytes

serum K+ levels may decrease when insulin administered - insulin promotes transport of K+ into cells

bicarbonate administration to reverse acidosis
specific tx to resolve causative factor of episode

Question 16

Pathophysiology; Hyperosmolar Hyperglycaemia Non-Ketoic Coma

Answer 16

freq TII
often elderly w infection
or
one who has overindulged in carbs - more insulin than anticipated

hyeorglycaemia and dehydration develop due to relative insulin deficits but sufficient insulin avlaible to prevent ketones acidosis

Question 17

SnS, Dx, Tx; Hyperosmolar Hyperglycaemia Non-Ketoic Coma

Answer 17

severe cellular dehydration = neuro deccas
muscle weakness
difficulties with speech
abnormal reflexes

as sufficient insulin to avaliable to prevent ketoacidosis is difficult dingoes initially