diabetes for finals
DESCRIPTION
Diabetes for finals . Dr Emma Hodgkins, FY1 . Globally 285 million people currently have diabetes , which is estimated to double by 2030. UK prevalence 4.5% (5.5% in England) Diabetes is currently the fifth most common reason for death in the world. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/1.jpg)
DIABETES FOR FINALS Dr Emma Hodgkins, FY1
![Page 2: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/2.jpg)
DIABETES WORLDWIDE Globally 285 million people
currently have diabetes, which is estimated to double by 2030.
UK prevalence 4.5% (5.5% in England) Diabetes is currently the fifth most
common reason for death in the world. Around 1 in 8 people between 20 and
79 years old have their death attributed to diabetes and it is expected to rise.
The life expectancy on average now is reduced by: More than 20 years for people with Type 1 diabetes Up to 10 years for people with Type 2 diabetes
![Page 3: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/3.jpg)
WHAT ARE THE DIAGNOSTIC CRITERIA FOR DIABETES?
![Page 4: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/4.jpg)
CRITERIA FOR DIAGNOSING DIABETES
Fasting Glucose > 7mmol/L Random glucose >11.1 mmol/mol 2h glucose >11.1 in an OGTT HbA1c > 6.5% (48 mmol/mol)
‘Pre-diabetes’ Impaired glucose tolerance = 2h glucose 7-11.1 Impaired fasting glucose = fasting 6.1-7.0
![Page 5: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/5.jpg)
HBA1C Two large-scale studies - the UK
Prospective Diabetes Study (UKPDS) and the Diabetes C ontrol and Complications Trial (DCCT) - demonstrated that improving HbA1c by 1% (or 11 mmol/mol) for people with type 1 diabetes or type 2 diabetes cuts the risk of microvascular complications by 25%.
Research has also shown that people with type 2 diabetes who reduce their HbA1c level by 1% are: 19% less likely to suffer cataracts 16% less likely to suffer heart failure 43% less likely to suffer amputation or death
due to peripheral vascular disease New = [Old % - 2.15] x 11
Old % = [New ÷ 11] + 2.15
![Page 6: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/6.jpg)
HOW DO YOU MANAGE DKA?
![Page 7: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/7.jpg)
DKA Diagnostic criteria: all three of the
following must be present capillary blood glucose above 11 mmol/L capillary ketones above 3 mmol/L or urine
ketones ++ or more venous pH less than 7.3 and/or
bicarbonate less than 15 mmol/L
![Page 8: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/8.jpg)
MANAGING DKA (2)Fluid replacement 1L NaCl over 1 hr1L NaCl with KCl over 2 hours, 1L NaCl with KCL over 2 hours1L NaCl with KCl over 4 hoursAdd 10% glucose 125ml/hr if blood glucose falls below 14 mmol/L
Potassium ReplacementSerum K > 5.5 NilK 3.5-5.540mmol/LK < 3.5 Seek Sr review
Insuin : Fixed rate insulin infusion(AFTER setting up IV fluids)
(0.1unit/kg/hr) 50 insulin (Actrapid® or Humulin S®) made up to 50ml with0.9% sodium chloride solution
Aims of treatment: Rate of fall of ketones of at least 0.5 mmol/L/hrBlood glucose fall 3 mmol/L/hr Maintain serum potassium in normal rangeAvoid hypoglycaemia
![Page 9: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/9.jpg)
MANAGING HONK AKA Hyperosmotic Hyperglycaemic state (HHS) Veinous access, bloods, blood cultures, blood gas 1L NaCl over 30 mins
Insulin therapy Aim to reduce glucose levels slowly, by
approximately 3 mmol/hour.Patients with HHS are often exquisitely sensitive to insulin and require much lower doses than in (DKA).
Mortality 10-20%
![Page 10: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/10.jpg)
HOW DO YOU MANAGE HYPOGLYCAEMIA?
![Page 11: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/11.jpg)
MANAGING HYPOS If Low GCS:
Protect Airway, 15L O2 IV access 50l 50% glucose STAT (100 of 20%, 200 of 10%) For large insulin OD give
1mg of glucagon SC/IM/IV Should respond in 10 min 1L 10% glucose over 4-8h Aim for BM > 5
If GCS 15 Oral glucose (120ml
lucuzade, HYPOSTOP/ Glucogel)
This only lasts 1h so give a sandwich too!
Monitor finger prick glucose 1-2 hrly until stable
![Page 12: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/12.jpg)
WHAT ARE THE STAGES OF DIABETIC RETINOPATHY?
![Page 13: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/13.jpg)
DIABETIC RETINOPATHY (1) Commonest cause of blindness in under 65s Background
Microaneurysms (Dots) Blot Haemorrhages, Hard Exudates (lipid leaked from aneurysms)
Pre-proliferative Cotton-wool spots, Beading & looping
![Page 14: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/14.jpg)
DIABETIC RETINOPATHY (2) Proliferative
New vessels around the disc & peripherally New vessels on the iris (rubeosis)
End Stage Vitreous haemorrhage, scarring, retinal detachment
Urgent Referral: Fall in acuity, 1 cotton wool spot, 3 blots, New vessels
![Page 15: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/15.jpg)
HOW DOES DIABETIC NEPHROPATHY OCCUR?
![Page 16: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/16.jpg)
DIABETIC NEPHROPATHYHyperglycaemia
Mesangeal Proliferation
Nephron loss
Activation of RAAS
Glomerular Hypertension
Hyperfiltration of protein
MicroalbuminaemiaProteinuria
Tubular damage
Cytokine adtivation
Inflammation
Glycation of proteins
Thick BM
![Page 17: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/17.jpg)
THE DIABETIC FOOT Combination of peripheral vascular disease &
neuropathy Lack of sensation to heat and trauma foot ulcers Impaired healing Charcot foot: osteoporosis, fracture and inflammation
– often presents as a hot swollen foot after minor trauma
Increased risk of osteomyelitis necrosis, gangrene & amputation
![Page 18: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/18.jpg)
WHAT IS YOUR LONG TERM MANAGEMENT STRATEGY FOR DIABETES?
![Page 19: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/19.jpg)
LONG TERM DIABETES MANAGEMENT
![Page 20: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/20.jpg)
INSULIN REGIMES
![Page 21: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/21.jpg)
DIABETES DRUGS
![Page 22: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/22.jpg)
GLP ANALOGUES & DPP4 INHIBITORS
![Page 23: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/23.jpg)
REFERENCES ABC of diabetes Oxford handbook of the foundation programme Oxford handbook of clinical medicine Dr Clarke- Medicine http://www.bsped.org.uk/clinical/docs/jbdsdkaguideli
nes_may11.pdf DKA guideline
http://www.bsped.org.uk/professional/guidelines/docs/DKAGuideline.pdf Paeds DKA
![Page 24: Diabetes for finals](https://reader030.vdocuments.net/reader030/viewer/2022033106/5681624d550346895dd2976f/html5/thumbnails/24.jpg)
Thanks and Good Luck!!