Diabetic Emergencies

Question 1

Presentation of DKA

Answer 1

Abdo pain, N+V, polyuria + polydypsia, reduced consciouness, kussmaul breathing

Question 2

What is kussmaul breathing?

Answer 2

Deep + laboured breathing - respiratory compensation to blow off CO2

Question 3

Give 3 possible causes of DKA

Answer 3

Infection
Poor compliance to insulin
New presentation of DM1

Question 4

How is DKA diagnosed (3 things, think D, K + A)

Answer 4

D: CAP glucose >11 or known diabetes
K: ketones +++ in blood or ++ in urine
A: Acidotic! pH <7.3 or HCO3 <15

Question 5

What are the principles of management in DKA?

Answer 5

Replace fluid + electrolytes

Insulin!

Question 6

How much saline do you initially give in DKA

SBP >90 and SBP <90

Answer 6

If SBP >90: 1L over 1st hour, then 2 L over 2nd hour

If SBP <90: give 500ml stat boluses and reassess BP

Question 7

What is the dose of insulin in DKA?

How quickly is it delivered?

Answer 7

50 units IV ACTRAPID insulin with saline made up to 50ml

Rate: 0.1 units per kg per hour

Question 8

When would you give potassium in DKA?

Answer 8

If serum potassium is <5.5

Question 9

What is the main difference in HHS and DKA?

Answer 9

In HHS there is no ketone production as there is RESIDUAL INSULIN IN DM2 - enough to prevent acidosis but not enough to prevent hyperglycaemia

Question 10

What are the 3 parameters for diagnosis in HHS?

Answer 10

Hypovolaemia
Marked hyperglycaemia (>30mmol/L)
Osmolality >320

Question 11

What is HHS usually precipitated by?

Answer 11

Some sort of illness/ infection/ dehydration

Question 12

How is HHS managed?

Answer 12

Rehydrate with saline! (at a slower rate than for DKA)

Insulin after an hour if glucose is still high: 50 units ACTRAPID, but at half the rate as for DKA

Question 13

What is hypoglycaemia?

Answer 13

Blood glucose <4 (4 IS THE FLOOR!)

Question 14

Presentation of hypoglycaemia

Answer 14

Drowsiness, confusion, numbess + tingling, seizure, coma

Nervousness, hunger

Question 15

Which 2 diabetes medications can cause hypoglycaemia?

Answer 15

Insulin + sulphonylureas (e.g. glicazide)

Question 16

Other than diabetes, give 3 causes of hypoglycaemia

Answer 16

Alcohol
Insulinoma
Addison’s (in an adrenal crisis)

Question 17

What can trigger hypoglycaemia in a diabetic?

Answer 17

Increased insulin
Increased activity
Not eating 
Alcohol
Infection

Question 18

How would you manage hypoglycaemia in a conscious patient?

Answer 18

10-20g glucose/ glucogel

Followed by: slow-release carbs

Question 19

How would you manage hypoglycaemia if the patient is unconscious (ABCDE, but the treatment)

Answer 19

IM glucagon 1mg

Followed by: IV dex (100-200ml of 10% dex)