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Diabetes Mellitus, DKA, Impaired Na+/K+ ATPase - Coggle Diagram

- - - - Diabetes-related
        
        Infection
        
        DKA
        
        Hypoglycaemic episode
      - Unrelated issue
  - - - What has been used in the past?
      - Have you seen changes in your weight since starting medication?
  - - - How often? and when (pre or post meals)?
        
        What are your levels usually at?
    - - Yes
        
        What were your symptoms?
        
        Fatigue
        
        Morning headaches
        
        Night sweats
        
        Weight gain
        
        Severe
        
        Seizures
        
        Coma (lack of glucose to brain)
        
        What triggered it?
        
        How was it managed?
      - More common in T1D
        
        Treat with 15 grams of fast-acting carbohydrate (nothing with fat as that slows absorption)
    - - Microvascular
        
        Retinopathy
        
        Cataracts
        
        Glaucoma
        
        Blurry vision
        
        Neuropathy
        
        Autonomic
        
        Gastroparesis (reduced gut smooth muscle motility)
        
        Nausea
        
        Vomiting
        
        Bloating
        
        Erectile dysfunction
        
        Postural hypotension
        
        Peripheral
        
        Numbness/tingling in extremities?
        
        Nephropathy
        
        Microalbuminuria tested with urine creatinine:albumin ratio
        
        Have you been told there's been protein in your urine?
        
        Dysuria
        
        Nocturia
        
        Oedema
        
        Hypertension
        
        Meds?
        
        ACEi or ARB generally taken for renal protection
        
        Any EUC abnormalities?
      - Macrovascular
        
        Coronary artery disease
        
        History of heart attack?
        
        Chest pain?
        
        Cerebrovascular disease
        
        History of stroke?
        
        Peripheral vascular disease
        
        Symptoms include
        
        Intermittent claudication (cramping/pain relieved with rest)
        
        Foot ulcers
    - - Exercise
      - Diet
      - Carb counting
  - - - High cholesterol
      - Hypertension
      - Smoking
    - - Coeliac
      - Thyroid issues
      - Addisons disease
    - - Vitamin B12
      - Iron
      - Folate
    - - Diet
        
        Eating regularly?
        
        Seen a dietician?
        
        Physical activity?
  - - - Drugs
    - - Does it stop you from doing anything?
    - - Sleep?
        
        Appetite?
        
        Energy levels?
- - - - Positive with one or more elevated levels
  - - - Fasting glucose levels above normal but below diabetes cutoff
        
        Both have very high rates of progressing to T2D and increased risks of cardiovascular complications
    - - 2hr Glucose during oral glucose tolerance test (oGTT) above normal but below cutoff
- - - - Venous or arterial blood glucose test (finger pricks not accurate enough)
        
        VBG: also assess for DKA
        
        pH, bicarbonate, lactate, electrolytes (esp. K+)
      - Blood tests
        
        EUC (electrolytes, urea, creatinine)
        
        LFTs
        
        FBC
      - Ketone measurement
        
        Ideally with a finer-prick blood ketone meter (ketones clear slower in urine so dipstick not preferred)
    - - pH < 7.3
      - Bicarbonate < 15mmol/L
      - Ketonaemia
      - Hyperglycaemia
  - - - Evidence of insulin deficiency
        
        Are they DKA?
        
        Ketosis?
    - - Insulin antibodies
      - GAD65 (Glutamic Acid Decarboxylase) antibodies
      - Islet Antigen 2 (IA-2) antibodies
      - Zinc Transporter 8 (ZnT8) antibodies
    - - C-peptide is co-secreted with insulin from the pancreas, thus serves as a marker for endogenous insulin production
        
        In T1D, as beta cells are destroyed, levels be very low or undetectable
  - - - Hashimoto's
      - Graves'
- - - - The presence of multiple autoantibodies confers a nearly 80% risk of progressing to clinical diabetes within 20 years
  - - - When the clinical diagnosis is traditionally made
- - - - Low insulin, high glucagon, high counter-regulatory hormones
        
        Hormone-sensitive lipase (HSL) suppressed by low insulin
        
        Increased beta-oxidation of triglycerides
        
        FFAs released from adipocytes
        
        FFAs bind to albumin
        
        Travel to liver
        
        1 more item...
        
        Insulin also inhibits gluconeogenesis
        
        Disinhibition of gluconeogenesis
        
        Insulin also promotes Malonyl-CoA synthesis
        
        Low insulin levels mean low Malonyl-CoA
        
        Malonyl-CoA
        
        Inhibits CAT I
        
        Low Malonyl-CoA from low insulin means low inhibition of the CAT I
        
        Glucagon & Cortisol stimulate gluconeogenesis