2. Before we start...
There’s a lot of information and you don’t need to know everything! We included
some extra information so you can have a better understanding.
Important info will be bolded or in red!
If you have any questions, don’t hesitate to ask!
3. First: what is diabetes?
Disease where body does not make or cannot respond to the hormone, insulin.
Insulin is needed to bring sugar (glucose) into cells.
Therefore, you end up with lots of sugar in your blood and not enough sugar in
your cells.
More to come on diabetes!
Source: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-
diabetes
4. Reflex Tachycardia
Definition: When a patient’s blood pressure is low, sensors for blood pressure in
the carotid sinus are triggered to increase heart rate. The increase in heart rate is
carried out via catecholamine release, such as the neurotransmitters epinephrine
and norepinephrine.
Image from: https://www.nhs.uk/Conditions/Supraventricular-tachycardia/Documents/carotid_sinus_massage_leaflet%5B1%5D.pdf
This are the same neurotransmitters involved in
the fight or flight response so they’ll increase heart
rate. (Hence: tachycardia = increased heart rate)
Hypotension = medical term of low blood pressure
5. Types of Shock
What is shock? Not enough blood
flow and therefore reduced oxygen
delivery to tissues.
Causes of Hypotension
More on shock:
https://www.youtube.com/watch?v=
kyD91-6kPLE
(you can ignore obstructive shock!)
Type of Shock Definition Cause
Hypovolemic Low blood
volume
Blood loss or
dehydration
(diarrhea or
vomiting)
Cardiogenic Reduced cardiac
output (reduced
heart force)
Congestive Heart
Failure, or other
heart diseases
Distributive Weak arteries Infection/sepsis,
anaphylaxis
(severe allergic
reaction - can’t
breathe)
6. BMI - Body mass index
● Rough estimate of one’s weight with respect to height. Calculated by
the formula Kilograms/M2
● Basically = patient’s weight/height
● Ranges: Underweight:
○ Less than 18.5
○ Normal weight: 18.5 - 24.9
○ Overweight: 25-29.9
○ Obese: 30 or more
● This method for measuring weight can be problematic because it doesn’t take
into account amounts of fat, bone, and muscle. For example, bodybuilders
who are very muscular may have a BMI that puts them as obese, even
though they don’t have much fat.
Image from: https://www.t-nation.com/training/how-natural-is-natural-bodybuilding
7. Differential Diagnoses for Diabetes Mellitus
Common Differential → more likely diagnoses
Condition: Symptoms Common w Diabetes:
Pregnancy Decreased blood pressure, nausea, and
increased urinary frequency
Urosepsis = Urinary tract infecting the whole
body
Hypotension, tachycardia, and polyuria
Acute Hyperglycemia = high sugar, can be due
to stress
Polyuria, nausea, blurry vision
Gastroenteritis = due to bacteria (usually E.
coli)
Nausea, vomiting, diarrhea, dizziness,
hypotension, and tachycardia
Adrenal Insufficiency = Also known as
Addison’s Disease, often genetic or due to
damaged adrenal glands
Hypotension, tachycardia, weight loss,
vomiting, diarrhea
8. Differential Diagnosis Continued
Condition: Causes: Symptoms in common w
Diabetes:
Anaphylaxis Allergic reaction Polyuria, nausea, vomiting,
diarrhea, hypotension,
tachycardia
Hypothyroidism Lower thyroid hormone
levels
Fatigue, hypotension,
bradycardia, myxedema
Pancreatitis Inflamed pancreas (like
after infection)
Nausea and vomiting
Congestive Heart Failure Weakened heart force of
contraction
Hypotension and
tachycardia
Less common differential
9. Other findings in Diabetes Mellitus
Acanthosis Nigricans - poorly defined velvety pigmentation in the body folds, also
common in obesity and pigmentation disorders
Acute Hyperglycemia - Common in diabetic patients with hypovolemic shock,
with higher glucose concentrations when blood volume falls
Orthostatic low blood pressure (low blood pressure when standing, often
associated with dizziness and lightheadedness on positional change), dry mucous
membranes (ex: lining of the lungs), and poor capillary refill (blood not reaching
capillaries) - commonly found in type 2 diabetes with hypovolemic shock
Diabetic Ketoacidosis - ketone bodies are a product of breaking down fat for
energy, which cause the body to become acidic. They buildup since the body is
unable to break down glucose for energy without insulin, and thus must use fats.
May lead to kussmaul breathing pattern.
10. Different Respiratory Patterns
Kussmaul breathing involves deep labored
breathing often seen in diabetic ketoacidosis.
Other patterns breathing patterns include
platypnea (difficulty breathing while standing
up right, better when lying flat), cheyne-stokes
(periodic breathing with variable breath
depths), and hypopnea (abnormally
slow/shallow breathing)
https://en.wikipedia.org/wiki/Cheyne%E2%80
%93Stokes_respiration#/media/File:Breathing
_abnormalities.svg
11. More Findings/Laboratory tests
Anion Gap is elevated in cases of metabolic acidosis, such as in diabetic
ketoacidosis. The anion gap is the difference between cations (positive ions) and
anions (negative ions). A value above 12 is considered high and indicates
metabolic acidosis.
Lab tests for diabetes:
The basic metabolic panel shows values for molecules commonly found in the
bloodstream, including glucose which is elevated in diabetes. The complete blood
count measures the number of red blood cells, white blood cells, and platelets.
Urinalysis tests for molecules in the urine, cases of diabetes may reveal glucose in
the urine. hcG (human chorionic gonadotropin) levels are used to rule out
pregnancy in the differential and serum ketones are often elevated in diabetes.
