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Diabetes Notes

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This is an extract of our Diabetes document, which we sell as part of our Endocrinology Notes collection written by the top tier of University Of Leicester students.

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Diabetes Type 1 Diabetes Epidemiology
- Can occur at any age, usually juvenile onset (13 years) Aetiology
- Genetic predisposition (HLA DR3 + HLA DR4) + environmental trigger (? Viral) Pathophysiology
- Autoimmune destruction of Beta cells of Islet of Langerhan (pancreas)
- Complete insulin deficiency Excess urine production due to osmotic effects of high blood Clinical features glucose retaining water in
- Classic triad o Polydypsia Excess water loss + osmotic o Polyuria effects of high glucose =
o Weight loss effects on thirst centres Lipolysis + proteolysis due to glucose not getting to tissues (ketone production) May present in DKA Fatigue Investigations
- Hx + postitive test or 2 positive tests on separate occasions o Fasting plasma glucose [?] 7.0mmol/L o Random blood glucose [?] 11.0 mmol/L o Oral glucose tolerance test [?] 11.0 mmol/L (75g in 300ml water)
- Urine dip for glycosuria
- HbA1c < 7.5% normally, <6.5% if increased CV risks (previous stroke/MI) Management
- MDT (nurse specialist, dietician, GP/consultant, podiatrist)
- Education o BMs, exercise, diet (reduce sat fats, sugar and increase starch carbs, moderate protein), smoking cessation, foot care o Inform DVLA (patient)
- Insulins o Dose adjustable regime to suit lifestyle
? BD regime = twice daily premixed insulin by pen injector e.g novomix 30
? QDS regime = before meals
? Once daily regime before bedtime - intermediate or longacting insulin o DAFNE course (dose adjustment for normal eating)
? If ill, insulin requirements increase even if food intake decreases


Increase BMs Increase insulin if glucose is higher Admit if patient is vomiting, dehydrated or ketotic

Diabetic Ketoacidosis (DKA) Lipolysis Free fatty acids Ketoacidosis (low pH)

ketone bodies

- Sluggish, extreme tiredness, extreme thirst, constant urination, fruity smell to breath (ketotic breath), hyperventilation, nausea, vomiting, abdominal pain, coma Precipitants
- Infection
- Surgery
- MI
- Non-compliance
- Wrong insulin dose For diagnosis need ketosis + acidosis Investigations
- Bloods o Glucose o U+E (risk of hypokalaemia with treatment of DKA, hyperkalaemia without) o Amylase (pancreatitis often present) o FBC (infection screen, WCC, platelets) o ABG (acidosis) o Cultures (infection screen)
- Imaging o CXR (Infection)
- Urinalysis (ketones)
- ECG (hyperkalaemia) Management
- Iv access
- Fluids (resuscitation with saline - boluses)
- Check plasma glucose
- NG tube if vomiting or unconscious
- Start insulin sliding scale
- Treat underlying cause
- K+ replacement +/- phosphate replacement Complications
- Cerebral oedema
- Aspiration
- Hypokalaemia
- Thromboembolism

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