Complications of Diabetes Flashcards
(25 cards)
Clinical definition of Diabetic ketoacidosis?
Acute uncontrolled diabetes associated with ketoacidosis requiring insulin and intravenous fluids for treatment
Biochemical definition of diabetic keto acidosis?
Biochemical definition
-↑ serum ketones (ketonemia/ketonuria)
-low p H with low serum bicarbonate
-associated with ↑ anion gap (how do we calculate the gap?)(6-12 mEq/l)
Pathogenesis of DKA?
Absolute or relative def
↑ counter regulatory hormones ; glucagon, cortisol, growth hormone, epinephrine
Promotion of gluconeogenesis, glycogenolysis & lipolysis
↑ in hyperglycaemia & free fatty acid
↑ end metabolites –ketone bodies(ketones, keto-acids,β hydroxybutyrate)
Ketones induce vomiting & nausea & ketotic breath
Glycosuria leads to osmotic diuresis & ↑ osmolality
Severe dehydration
History of DKA?
compliance
Clinical exam findings IN DKA?
- source infections
- myocardial infarction
- DVT
Investigations in DKA?
- plasma glucose
- urine/serum ketones
- ABG
- U & E
- FBC
- osmolality
- Renal function
- urine/blood culture
Principles of treatment of DKA?
- fluid replacement
- insulin
- potassium replacement
- correction of acid base balance
- treat underlying recipitants
Fluid replacement in DKA?
N/S 0.9% or R/L:1-
1. 3L 1st hour
2.1L 2nd hour
3.1L 2hrs
4.1L every 4 hrs
- depending on the degree of dehydration
Insulin use in DKA?
- Start 1 hr after rehydration
- Ideally via an infusion pump /regular insulin at 0.1 U/Kg/hr
- Optimal glucose drop @100/mg/hr in 4-5 hrs(not allow to drop below 200mg/dl)
Potassium replacement in DKA?
- 20-40mEq/L if potassium is normal or low to each litre
- 6mEq/L=no replacement
- 4-6mEq/L=10mEq/hr
- 3-4.5mEq/L=20mEq/L
What is hyperglycaemia hyperosmolar state?
- Hyperglycaemia, hyperosmolar, dehydration without significant ketoacidosis
- Common in type 2 DM & usually precipitated by infections
Clinical assessment of HHS?
- Glucose ~ 600mg/dl
- Osmolality ~ 320mOsm/kg(?calculation)(285-295mmol/kg)
- Serum Ph >7.30
- Bicarb> 15 mEq/l
- Altered consciousness
- Small or no ketonuria
HHS pathogenesis?
- increase in glucose causes osmotic shift out of cells causing intracellular dehydration
- no DKA due to basal insulin which is sufficient to stop ketogenesis but not to reduce glucose
- usually old patient and first presentation of diabetes
- can be precipitated by illness and dehydration
What is Hypoglycemia?
Blood glucose <40mg/dl(<2.5 mmol/l)
Usually have adrenergic and neuroglycopenic symptom
Management of hypoglycemia?
- 50 mls of 50% dextrose until glucose is within 5-10 mmo/l
- maintain with 10% dextrose to cover sulphonylurea effect(add 10 mls of 50 % dextrose to every 100 mls of 5% dextrose)
- allow to eat when fully awake
Microvascular complications of diabetes?
small vessel damage
1. retinopathy
2. nephropathy
3. neuropathy
Macrovascular complications of diabetes?
medium/larger vessel damage
1. Myocardial infarction
2. stroke
3. PVD
Macrovascular damage of medium to large cells?
Due to atherosclerosis there is increased risk of;
1. Myocardial infarction; usually tends to be silent
2. Cerebral vascular disease-stroke
What is atherosclerosis?
- plaque with fibrous cap
- cap ruptures
- blood clot forms around the rupture, blocking the artery
Retinopathy in diabetes?
- Pre-proliferative and proliferative retinopathy(see slides)
- Glaucoma
- cataract
Progression of diabetic nephropathy?
- Control HPT & proteinuria with ACE inhibitors
- Tight glycaemic control
- Lipid lowering agents
- Consider SGLT2 inhibitors
- CKD stage 5
- Consider dialysis
Motor neuropathy?
- muscle weakness > foot drop
- muscle imbalance > deformities
Sensory neuropathy?
- loss of feeling > loss of protective sensation, ulcers
- loss of proprioception > poo balance
Autonomic neuropathy?
- loss of sweat > dry cracked skin, ulcers
- changes in blood flow > Charcot arthropathy
