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Diabetes Notes

This is a sample of our (approximately) 6 page long Diabetes notes, which we sell as part of the Endocrinology Notes collection, a MBChB (hons) (1st) package written at University Of Leicester in 2014 that contains (approximately) 28 pages of notes across 7 different documents.

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Diabetes Revision

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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 

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

Symptoms
- 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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