Diabetic Complications Flashcards
(33 cards)
DKA is a complication of which type of diabetes
Type 1
what can precipitate a DKA
Missed insulin doses Infection MI
what is a DKA
uncontrolled lipolysis – free fatty acids fatty acids converted to ketone bodies ketone bodies cause a metabolic acidosis
what is Kussmauls breathing
hyperventilation seen in DKA
Symptoms of DKA
abdo pain thirst nausea + vomiting acetone breath - sweet smelling breath
Signs of DKA
hyperglycaemia ketonuria Ketonaemia acidosis sweet acetone breath dehydration tachycardia potassium imbalance
diagnosis of DKA (3 things)
hyperglycaemia: glucose >11mmol ketosis: blood ketones >3mmol acidosis: pH <7.35
management of DKA
FIG PICK
FLUIDS -IV fluid
INSULIN- 50 units actrapid
GLUCOSE - closely monitor
POTASSIUM - hypokalaemia with insulin, monitor + correct as needed
INFECTION - Treat any underlying cause
CHART - fluid balance chart
KETONES - monitor
max rate potassium can be infused at
10mmol per hour
what is important to commence before removing insulin/fluid infusion in treating DKA
Patient has commenced normal s/c insulin regime prior to stopping
definition of hypoglycaemia
blood glucose below 4mmol/L
symptoms of hypoglycaemia
tremor
sweating
dizziness
pallor
irritbility/ anxiety
— can lead to reduced consciousness, coma, death if untreated
treatment of hypoglycaemia
oral glucose + complex carb afterwards
IM glucagon
IV glucose (125mls 20%, 250mls 10%)
macrovascular complications
coronary artery disease
peripheral vascular disease
stroke / MI
Microvascular complications
peripheral neuropathy
retinopathy
nephropathy
diabetes increases risk of what infections
UTIs
pneumonia
skin/soft tissue - particularly feet
fungal - particularlly oral/vaginal candiasis
Target BP diabetes with
- no end organ damage
- end organ damage (mirco/macrovascular complications)
no end organ damage = 140/80
end organ damage = 130/80
bloating + vomitting in Type 1 diabetic with erratic blood glucose control should make you think of what diagosis ?
gastroparesis
- neuropathy of vagus nerve
treatment of gastroparesis
pro-kinetic e.g. metaclopramide, domperidone, erythromycin
appearance of a neuropathic foot ulcer
punched out appearance
on plantar surface
foot deformity in diabetes
charcot foot
appearance of diabetic retinopathy on fundoscopy
microaneurysms: small red dots
dot + blot haemorrahages from aneursym rupture
hard exudates: lipid + protein leak from vessels
cotton wool sports: retinal nerve fibre ischaemia
hyperosmolar hyperglycaemic state (HHS) is a complications of which type of diabetes
Type 2
what is HHS usually associated with
dehydration
hypernatraemia
