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Diabetes Emergencies Complications
Diabetes Emergencies Complications
Diabetes Emergencies Complications
3ed level
J. U. For Medical & Health sci.
Faculty Of Nursing Second term
Diabetes Emergencies
Complications
BY:
OSAMA ALSHOAPI
Diabetic Emergencies
• Diabetic ketoacidosis
• Hypoglycaemia
Signs
• Air hunger (Kussmaul breathing) • • Dehydration
• • Smell of acetone • • Hypotension (postural or supine)
• • Hypothermia • • Cold extremities/peripheral cyanosis
• • Delirium, drowsiness, coma (10%) • • Tachycardia
1. Insulin
2. Fluid replacement
3. Potassium
4. Bicarbonate
3 L extracellular Water: 6 L
– replace with saline • Sodium: 500 mmol
3 L intracellular • Chloride: 400 mmol
– replace with dextrose } • Potassium: 350 mmol
2. Fluid replacement
• Rapid fluid replacement in the first few hours is usually recommended .
• Caution is recommended in children and young adults because of the risk of
cerebral oedema. Most current guidelines favour correction of the extracellular
fluid deficit with isotonic saline (0.9% sodium chloride).
• In the UK, it is recommended that all glucose levels < 4.0 mmol/L (72 mg/dL) are treated (‘4 is
the floor’). People with diabetes who recognise developing hypoglycaemia are encouraged to
treat
• immediately. Options available include:
Oral fast-acting carbohydrate (10–15 g) is taken as glucose drink or tablets or confectionery,
e.g. 5–7 Dextrosol tablets (or 4–5 Glucotabs), 90–120 mL original Lucozade, 150–200 mL pure
fruit juice, 3–4 heaped teaspoons of sugar dissolved in water)
Repeat capillary glucose measurement 1–15 mins later. If still < 4.0 mmol/L, repeat above
treatment
If blood glucose remains < 4.0 mmol/L after three cycles (30–45 mins), contact a doctor.
Consider glucagon 1 mg IM or 150–200 mL 10% glucose over 15 mins IV
Once blood glucose is > 4.0 mmol/L, take additional long-acting carbohydrate of choice
Do not omit insulin injection if due but review regimen
• Macrovascular
• Coronary circulation
Myocardial ischaemia/infarction
• Cerebral circulation
Transient ischaemic attack • Stroke
• Peripheral circulation
Claudication • Ischaemia
22 Osama foud Alshoapi
Diabetic retinopathy
• Microaneurysms and retinal haemorrhages.
• Cotton wool spots, venous beading and intra-retinal microvascular abnormalities.
• The disease may then progress to proliferative DR, which is characterised by
Growth of new blood vessels on the retina or optic disc .
• The new vessels are abnormal and often bleed, leading to vitreous haemorrhage,
subsequent fibrosis and scarring, and finally tractional retinal detachment
• Among the most common causes of end-stage renal failure in developed
countries.
• About 30% of patients with type 1 diabetes have developed diabetic nephropathy
20 years after diagnosis, but the risk after this time falls to less than 1% per year.
• Visceral (autonomic)
• Cardiovascular
• Gastrointestinal
• Genitourinary
• Sudomotor
• Vasomotor
• Pupillary