Diabetic Emergencies Flashcards
Describe the feedback loop in response to absolute/relative insulin deficiency.
Absolute deficiency - DKA
Relative Insulin deficiency - HHS state (not necessarily ketosis as there would be some insulin to shut down that process, but not enough to bring down glucose)
What are signs and symptoms of DKA?
CNS - polydipsia, polyphagia, lethargy, stupor
Visual - blurred vision
Breath - smell of acetone
GI - abdominal pain (might be confused for other conditions), vomiting, nausea
Urinary - Polyuria, ketouria, glucosuria
Respiratory - Hyperventilation
- Sudden weight loss
Sglt2 inhibitors could cause euglycaemic ketoacidosis
yes
What are characteristics of DKA and HHS respectively?
30% can present with both conditions
What are clinical manifestations of DKA/HHS?
What are important tests to do if suspected DKA/HHS?
DKA can be diagnosed within minutes
What are the sequence of treatment goals in DKA?
What is the detailed treatment plan for DKA?
What are some more hidden traits of DKA?
What is HHS?
What is the glycaemic and osmolarity cut-off for HHS?
Hyperosmolarity - 320
What are main precipitants of HHS?
Infection (30-60%)
Stroke, MI
Trauma or something that has compromised water intake. (elderly)
Other endocrine disorders that lead to insulin resistance; hyperthyroidism, acromegaly, hypercortisolism
Iatrogenic (steroids)
Non compliance with diabetes medications (OHA, Insulin in those with T2)
Newly diagnosed diabetes (7-17%)
1/3 present with HHS and DKA
What are principles of HHS treatment?
If they don’t have ketones, insulin is not needed
Compare and contrast DKA and HHS
Describe normal and abnormal response to hypoglycaemia
Describe the protocol of managing mild/moderate/severe hypoglycaemia?
