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Flashcards in Endocrine - Online MedEd - Diabetic emergencies Deck (21):
1

One episode of hypoglycaemia can be deadly!
Diabetic and hypoglycaemia - usual cause?

Doctors might - too much insulin/too much meds
Patient might - exercise too much, eating too little, sepsis

2

Diabetic and hypoglycaemia - what to do?

Give oral glucose load
Candy, juice, non-diet soda - something with rapid acting glucose
If patient is in COMA --> cannot take oral, give IV
*This is an emergency

3

Patient will know if hypoglycaemic - symptoms?

Palipitations
Diaphoresis
Presyncope
Progress to coma

4

Diagnosis of hypoglycemia

Check glucose

5

Causes of hypoglycemia

Less medicine?
Exercise carry snacks
Need to figure out why got hypoglycaemia*

6

If patient normally has high sugars... they might experience hypoglycaemic symptoms at high glucose values - what to do?

Treat if there are the symptoms

7

What happens if hypoglycaemic and not diabetic? true hypoglycaemia with symptoms... 2 causes:

1) Insulinoma
2) Factitious
3) Abs

8

Insulinoma - tests to do

Wait for hypoglycemic:
Low glucose
C peptide - ELEVATED
Pro-insulin
Secretagogue screen

9

Pro-insulin is packaged with C peptide and where is insulin?

Insulin part of pro-insulin
-In insulinoma, if there is too much pro-insulin there will be too much insulin + c peptide *coming from body
-This is endogenous production
-But still might be giving too much medication, recall that oral sulfonyureas induce insulin production
-So do secretagogue screen!
-So if sulfonylurea screen is positive --> they are ingesting! tell them to stop
-If sulfonylurea screen is negative --> consider insulinoma

10

Factitious cause of hypoglycaemia - lab values

Low glucose
Low C peptide
High insulin
Tx: tell them to stop injecting

11

Insulinoma - definitive dx

This is after C peptide is high and secretagogue test is negative
Do a 72 hour fast
and do process again
wait for hypoglycemic
-Once confirmed, get CT/MRI abdomen

12

DKA - pathology

Disease that Type 1 get
Type 2 can go to DKA - HHS more common
-Lots of sugar in blood but no insulin
-So body thinks it is starving --> produce ketones --> ketoacidosis
-Intact kidneys --> glucose into urine --> massive osmotic diuresis = profound dehydration

13

DKA - presentation

Diabetic coma
Ketones
Acidosis

14

Dx of DKA

Blood glucose
Urine ketones+
Might check serum ketones (better answer, but takes longer)
Get ABG - acidosis
Also need: anion gap and K

15

Treatment of DKA

Follow DKA protocol
What to look for: watch Glucose, Potassium, Anion Gap
-Glucose - need insulin, 10 units IV insulin with insulin drip
-Recall glucose/insulin shift of K into cells --> give KCl IV (replace K)
-Gap is fixed by insulin!
-Bolus, vigorous hydration NS/lactated Ringer's
-Glucose might be normal, but gap is still open
-Insulin needs to be continued until gap closes
-As glucose starts to fall, but gap remains open --> start D5/give sugar
-Once gap is closed --> bridge to long acting SubQ insulin and get them off the drip
-If gap reopens, start over

16

Reason of DKA...

Noncompliance with insulin
Infection
NSTEMI
*Might need to be treated

17

Type 2 goes into what (not DKA)

HHS - hyperosmolar hyper osmotic state

18

Pathology of HHS

Type 2s
Same thing: diabetic coma, no ketones, no acidosis *this is because they have a little bit of insulin (unlike type 1)
Cells are still getting some energy
*Therefore, do not present acutely and are not acutely ill

19

Difference between HHS and DKA

No acidosis --> not acute illness
But have really really high blood glucose, osmotic diuresis is even worse and profoundly dehydrated
Coma
-Both diseases are equivalent, require ICU

20

Dx of HHS

BG (very high)
U/A obtained - no ketones
ABG - no acidosis
Check K and gap - gap is negative

21

Treatment of HHS

Need lots of fluids
IV insulin
-Need much more fluids than DKA
-No gap to follow!