Clinical demonstration : diabetes, coma and complications Flashcards Preview

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Flashcards in Clinical demonstration : diabetes, coma and complications Deck (18):
1

What are the acute complications of diabetes?

Hypoglycaemia
Diabetic coma

2

What are the chronic complications of diabetes?

Microvascular - neuropathy, retinopathy, nephropathy
Macrovascular - IHD, CVA, PVD

3

Describe acute hypoglycaemia?

Low glucose in brain and muscles
BRAIN - double vision, slurred speech, lack of concentration, confusion, behaviour change, epilepsy
MUSCLES - shaking, tremble, sweat, pins and needles, hunger, headache, palpitations

4

What is the normal response to low glucose in the blood?
And what happens to this mechanism when hypoglycaemic?

Brain:
-GH - decreased peripheral glucose uptake
- ACTH - adrenal:
-- cortisol - decreased peripheral glucose uptake
-- adrenaline - liver - increase production of glucose (when combined with glucagon acting on the liver, released from the pancreas)
When hypoglycaemic, the pancreas doesnt release and glucagon and so the liver doesnt make more glucose

5

What are the causes of hypoglycaemia?

missed meals, alcohol, unaware, too much insulin

6

What is the treatment for hypoglycaemia?

IF PT CONSCIOUS - oral glucose and long lasting carbs
IF PT DROWSY - hypostop
IF PT UNCONSCIOUS - s/c glucagon, IV 50% dextrose

7

What are the 2 types of diabetic coma?

Diabetic ketoacidosis (DKA) 25% mortality
Hyperosmolar nn- ketotis hyperglycaemia (HONK)

8

What are the signs and symptoms for DKA?

SIGNS:
tachycardia, dehydration, hyperfentilation, ketotic breath, hypotension, coma
SYMPTOMS:
vomiting, thirst, polyurea, abdominal pain, weak, lethargy

9

What 3 things do you need to know to diagnose DKA?

blood sugar >15
urine ketones >2+
blood pH

10

What are the causes of DKA?

inadequate insulin, surgery, infection, pregnancy

11

How does DKA occur?

Insulin lack - breakdown fat- increased ketogenesis - ketoacidosis
Decreased glucose uptake - increased hepatic output - hyper glycaemia - osmotic diuresis (low K+, Na+, Cl-) - dehydration - hypotension

12

What is the treatment for DKA?

IV insulin if insulin deficiency
IV dextrose if starving
IV saline if dehydrated
Treat underlying disorder

13

What is HONK?

commonest coma in type 2 diabetes
similar presentation and treatment to DKA
NO KETONES AND NO ACIDOSIS

14

What 4 things do you need to know to diagnose HONK?

blood glucose >30
pH blood >7.2
urine ketone 350

15

What is the treatment for HONK?

Heparin if clotting risk
IV insulin if insulin deficiency
IV dextrose if starving
IV saline if dehydrated
Treat underlying disorder

16

Describe chronic hypoglycaemia?

Microvascular and macrovascula

17

Describe microvascular disease?

HbA1c dependant, not in IGT, not in type 2,

18

Describe macrovascular disease?

HbA1c independant, present in IGT, metformin decreases risk, F>M
Factors affecting it: microalbuminurea, BP, insulin concentration, weight, cholesterol