PROGNOSIS, KEY INFORMATION, EXTRA’S
PROGNOSIS
Complications:
- Microvascular: retinopathy(50%), nephropathy(20%), neuropathy (linked to diabetic foot, erection issues & autonomic neuropathy)
- Macrovascular: MI (4x risk), stroke (3.5x risk), PVD
- Metabolic: DKA, hypoglycaemia (BG <3.5mmol/L)
- DKA: Needs admission o BG>11
- Ketones raised (urine: 2+ & blood >3mmol/L, can do both in adults, but only do a blood test in kids)
- Polyuria, Polydipsia o Persistent V&D
- Confusion & Visual Disturbances o Abdominal Pain o Acetone Breath o Acidotic breathing (Kussmaul’s breathing)
- Dehydration & shock
- Precipitating factors: infection, stressor, Diabulimia, other medical conditions like pancreatitis, drugs like Corticosteroids
- Hypoglycaemia:
- Mild: Hunger, irritability, sweating, palpitations, tremors
- Moderate: Impaired Vision, reduced orientation & coordination, confused and impaired cognitive function
- Severe: Can’t swallow, convulsions, LOC, coma o Treatment: replenish glucose stores, orally if possible, if not, consider IM
Glucagon, if this is not possible, then needs IV access for IV Glucose
- Psychological: anxiety, depression, eating disorders
- Associated autoimmune conditions: coeliac disease, Addison’s, thyroid disorders
- Infections: UTIs, skin infections (necrobiosis lipoidica)
KEY INFORMATION
- Immediate referral required for new diagnosis
- Never stop/omit insulin
- DVLA notification required
- Group 1 drivers: max 1 hypo in 12 months, cannot be in the last 3 months – Group 2 drivers: no hypos permitted in last 12 months
EXTRA’S
Patient with new-onset DM + weightloss + >60 – needs direct access CT to rule out pancreatic cancer.