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Diabetic Foot
Diabetic Ketoacidosis
Non Ketotic Hyperosmolar Coma
Drugs Used In Diabetes Mellitus
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Diabetes Mellitus
- Lack of Insulin or resistance to insulin
- Type I = insulin dependent / autoimmune
- Type II = non-insulin dependent / insulin resistance
Emergencies
Types
Type I
- young patient
- thin
- short history
- often presents in diabetic
ketoacidosis
- treated with insulin from time of diagnosis
- association with HLA-DR3 / HLA-DR4
Type II
- middle-aged / overweight
- often present sub-clinically
- may be treated with diet alone / oral hypoglycaemics
Secondary diabetes
- Gestational
Diabetes
- Liver
- Pancreatic disease
- Endocrine
- Drug-induced
- Insulin-receptor abnormalities
- congenital lipdystrophy
- acanthosis nigricans
- Genetic syndromes
Presentation
- Polyuria
- Thirst
- Weight loss
- Complications
Complications
History
PMH
- Hypertensive
- Other complications / admissions
FHx
- increased incidence in relatives
DHx
- Diet
- Oral Hypoglycaemics
- Insulin
ROS
Driving
- Diabetic drivers must report their condition and treatment to the DVLA and
check their blood glucose before driving or every 2 hours on long journeys
Examination
General
- Well / Unwell
- Thin / Obese
CVS
Abdo
CNS
- visual acuity
- fundoscopy
- peripheral neuropathy
- absent ankle jerks
- distal sensory loss
- neuropathic ulcers
Investigations
Diagnosis
- fasting blood glucose >7.0 mmol/l
- random blood glucose >11.0 mmol/l
Others
Cut off values in diabetes
Treatment
Blood Glucose monitoring
- Many patients monitor their own BG using BG strips and an electronic
meter.
- BG fluctuates over 24 hours.
- Ideal BG is in the range 4-10 mmol/litre for most of the time (it may rise
above that for short periods)
Diet
Control other complications
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