Lec 2 Diabetes Complications Flashcards
(64 cards)
What is diabetic ketoacidosis (DKA)?
A result of absolute or relative insulin deficiency coupled with a rise in counter regulatory hormones leading to hyperglycemia, osmotic diuresis, ketone production, acidosis, and potentially coma and death if untreated.
In which type of diabetes does DKA primarily occur?
Type 1 Diabetes Mellitus (T1DM)
What are the precipitating factors for DKA?
- Insufficient or interrupted insulin therapy
- Infection
- Emotional stress
- Excessive alcohol ingestion
What are the three biochemical abnormalities present in DKA?
- Blood glucose > 200 mg/dl
- Ketonemia ≥ 3 mmol/L or significant ketonuria (> 2+)
- Acidosis: HCO3− < 15 mmol/L and/or venous pH < 7.3
What are the clinical signs of DKA?
- Anorexia, nausea, vomiting
- Abdominal pain
- Kussmaul respiration
- Fruity breath odor of acetone
- Signs of dehydration
- Altered consciousness to coma
What should prompt consideration of admission to ICU in DKA?
- Blood ketones > 6 mmol/L
- HCO3− level < 5 mmol/L
- pH < 7.1
- Hypokalemia < 3.5 mmol/L
- Abnormal Glasgow Coma Scale
- O2 saturation < 92% on air
- Systolic BP < 90 mmHg
- Anion gap > 16
What is the management of DKA?
- Fluids
- Insulin
- Electrolyte replacement
What is Hyperosmolar Hyperglycemic State (HHS)?
A syndrome occurring predominantly in type 2 DM characterized by severe hyperglycemia and hyperosmolarity in the absence of significant ketosis.
What are the precipitating factors for HHS?
- Noncompliance with treatment
- Inability to drink sufficient water
- Infections
- Strokes
- Steroids
- Immunosuppressant agents
- Diuretics
What is the typical blood glucose level in HHS?
Typically 600-1200 mg/dl
What is the defining characteristic of hypoglycemia?
Blood glucose level < 72 mg/dl
What are the levels of hypoglycemia?
- Level 1: < 72 mg/dl
- Level 2: < 54 mg/dl
- Level 3: Severe hypoglycemia requiring assistance
What are common causes of hypoglycemia?
- High insulin or sulphonylurea dose
- Missed meals
- Increased physical activity
What is the management of conscious adults with hypoglycemia?
- Give 15-20g of quick-acting carbohydrate
- Repeat blood glucose measurement after 10-15min
What should be given if blood glucose remains < 72 mg/dl after three cycles?
- 1mg of glucagon IM or 10% glucose IV infusion at 100mL/h
What is hypoglycemic unawareness?
A condition where recurrent hypoglycemia reduces hormonal and symptomatic responses, leading to the inability to recognize hypoglycemia.
What is the role of advanced diabetes technology in management?
Helps in management through continuous glucose monitoring (CGM) and insulin pumps.
What is the recommended carbohydrate intake for treating hypoglycemia?
- 15-20g of quick-acting carbohydrate
- Followed by 15-20g of long-acting carbohydrate once stabilized
What is the normal plasma osmolality range?
275-295 mosm/kg
What is the typical serum osmolality in HHS?
Usually > 330 mosm/kg
What can result from acidosis and electrolyte disturbance in DKA?
Fatal rhythm disturbance
What should be monitored hourly during DKA management?
- Conscious level
- Vital signs
- Urine output
- Glucose
- Urine ketones
- Blood ketones
- Venous blood gases
What is essential to diagnose Hypoglycemia Without Diabetes during a symptomatic attack?
Measurements of glucose, insulin, and C-Peptide
High insulin and C-peptide levels indicate insulinoma or exogenous SU, while high insulin and low C-peptide suggest exogenous insulin administration.
What are the microvascular complications of diabetes mellitus (DM)?
Retinopathy, Nephropathy, Neuropathy
These complications affect over 80% of individuals with diabetes.
