Presentation on theme: "At GP surgery: BGL 25mmol/L – referred to ED In ED: Capillary blood gas: pH 7.18, bicarbonate (HCO3) 12 mmol/L, BGL 25 mmol/L, Na 136 mmol/L (corrected."— Presentation transcript:
At GP surgery: BGL 25mmol/L – referred to ED In ED: Capillary blood gas: pH 7.18, bicarbonate (HCO3) 12 mmol/L, BGL 25 mmol/L, Na 136 mmol/L (corrected = 142), K 4.9 mmol/L Corrected Na = measured Na + 0.3 (glucose – 5.5)
Management: 10ml/kg bolus Normal saline Re-assessed: PR 118, RR 36, BP 96/58 IV insulin infusion: 0.1U/kg/hr Fluids: N/S + 40mmol/L KCL at maintenance + 5% replacement over 48 hrs Transferred to HDU – further management as per DKA protocol
A1C ≥6.5% OR Fasting plasma glucose ≥7.0 mmol/L OR 2-h plasma glucose ≥11.1 mmol/L during an OGTT OR A random plasma glucose ≥11.1 mmol/L Diabetes Care 2013;36(suppl 1):S13; Table 2.
Categories of increased risk for diabetes (prediabetes) IFG: 5.6–6.9 mmol/L OR IGT: 2-h plasma glucose in the 75-g OGTT 7.8–11.0 mmol/L OR A1C 5.7–6.4% *For all three tests, risk is continuous, extending below the lower limit of a range and becoming disproportionately greater at higher ends of the range. Diabetes Care 2013;36(suppl 1):S13; Table 3.
Cow’s milk protein exposure (bovine serum albumin and β-lactoglobulin) Vitamin D deficiency Viruses: coxsackie A or B, enterovirus, rubella, cytomegalovirus, ECHO virus, EBV, mumps, retrovirus Drugs & toxins: eg alloxan-like or streptozotocin- like agents that induce oxidant beta-cell damage Stress The Environmental Determinants of Diabetes in the Young (TEDDY) study
Health Psychol. 1992;11:135-138 Diabetes Care. 1996;19:876-879; Diabetes Technol Ther. 2008;10:69-80. Glucose variability Reluctance to intensify therapy High A1C Complications Morbidity Mortality Complications Morbidity Mortality Quality of life Fear of hypoglycemia Severe hypoglycemia Controversial