Final Prep - Diabetes Flashcards


Hypoglycemia

BS <55 brain damage develops when brain is deprived
of needed glucose after dramatic drop in BS insulin
reaction, insulin dose not matched to carb intake or exercise


Hypoglycemia
Mild S/S

diaphoresis pallor paresthesia
palpitations tremors anxiety


Hypoglycemia
Moderate S/S

confusion / disorientation behavioral changes
cold, clammy extremities yawning tremors
blurred vision


Hypoglycemia
Severe S/S

seizures loss of consciousness shallow
respirations severe hypoglycemia can result in death


Hypoglycemia Dx

S/S finger stick blood sugar venous blood
work


Mild
Hypoglycemia Mgmt

simple sugars p.o.
8oz fruit juice 8oz skim milk 3 glucose
tabs 3-4oz reg soft drink 3-4 pcs hard candy
1tbsp sugar 5ml pure honey


Hypoglycemia Rules

15/15 rule: wait 15min & monitor BS, if still low (<80),
pt eat another 15g of sugar continue until BS level is
normal pt should contact HCP if hypoglycemia occurs >
2-3x/wk


Hypoglycemia
Tx - Unconscious Pt

glucagon 1mg SQ, IM, IV - follow w/ PO/IV carb
action: raises BS levels onset:10min, duration
25min SE: N/V position: sidelying
25ml of D50 IV push - follow w/ infusion of D5 H2O


Hypoglycemia
- Elderly Considerations

cognitive deficits: not recognize S/S dec. renal fx:
PO hypoglycemic meds stay in body longer more likely to
skip a meal vision problems: inaccurate insulin draws


Hypoglycemia
Pt Teaching

carry simple sugars at all times S/S Tx
check BS asap if hypoglycemia suspected wear ID
bracelet family or friends - S/S inc. belligerence

Hyperglycemia Complications

high BS
DKA
HHS


DKA -
Diabetic Ketoacidosis

Causes

usually occurs w/ type I DM (BS >250) absence or
lack of insulin, breakdown of fat & overproduction of ketones by
liver & loss of bicarb top causes: illness, infection,
stress, surgery, trauma, pregnancy taking too little
insulin, missed doses increased energy needs
initial or undiagnosed diabetes developing insulin
resistence


DKA - 4 Main Features

hyperglycemia dehydration electrolyte
loss metabolic acidosis


DKA - S/S

hyperglycemia
inc. BS fatigue polyphagia dec.
attention, confusion N/V, ab pain blurred
vision
dehydration
polydipsia polyuria dry/flushed skin
orthostatic hypotension tachycardia H/A
dec. Na+ & K+
acidosis
inc. respirations - Kussmaul's fruity, acetone
breath serum pH decreased


DKA Mgmt

IV insulin rehydrate w/ IV fluids replace K+
& monitor closely
acidosis
reverse w/ insulin (dec. fat metab & ketones)


Sick Day Rules

never omit insulin if unable to eat normally, don't
miss insulin dose if unable to eat usual meal, sub. w/ soft
foods (have sick day foods available) sliding scale
test BS q 3-4hr test urine for ketones q 3-4hr
take liquid/fluids q hr if vomiting, diarrhea, fever
persist: liquids q 1/2hr if miss or replace 4 meals w/
fluids - call MD


HHS -
Hyperosmotic Hyperglycemic Syndrome

occurs when insufficient insulin to prevent hyperglycemia, but
enough insulin to prevent ketoacidosis occurs in all types
of diabetes life threatening emergency w/ high mortality
rate


HHS Factors
/ Causes

infection (most common) planned procedure
acute or chronic illness overeating
stress too little insulin


HHS - S/S


plasma osmolarity >= 340 (norm 280-300)
very high BS - 600-1000 (norm 70-110)
altered LOC (lethargy to coma)
neuro deficits: hyperthermia, motor & sensory
impairment, seizures
dehydration: dry skin & mucous membranes,
extreme thirst


HHS - Mgmt

usually ICU for care if unresponsive - ventilator
& NG suction vigorous fluid replacement
insulin IV - lower BS w/ insulin until level = 250 K+,
NaCl by IV dextrose when BS at 250 to prevent
hypoglycemia treat precipitating factors


DKA &
HHS Nursing Role

insulin hydration electrolyte replacement
& monitoring ASSESS


Other
Hypo/Hyperglycemia Complications


Dawn phenomenon: rise in BS b/t 4-8am
Somogyi effect: combo of hypoglycemia during night
w/ rebound morning hyperglycemia -> insulin resistance for
12-48hrs


Diabetes
Chronic Complications

macrovascular
arteriosclerosis CAD CVD PVD
microvascular
basement membrane thickening effects smallest blood
vessels: eyes, kidneys, skin

Cardiovascular Disease

major cause of mortality in pts w/ Type II DM approx.
2/3 of people w/ diabetes die from heart disease or stroke
men w/ DM have 2x inc. risk & women have 3-4x inc. risk for
CAD more likely to develop MI & CHF 2-4x higher
risk for CVA 20-60% of diabetics have HTN


Peripheral
Vascular Disease

Types I & II both at inc. risk arterial occlusion
& thrombosis result in gangrene, most common cause of
non-traumatic lower limb amputation

Diabetic Nephropathy

most common cause of ESRF in US glomerular changes in
diabetic's kidneys lead to impaired renal fx (Kimmelsteil-Wilson
syndrome) damage to tiny blood vessels in kidney d/t
hyperglycemia, stresses kidney's filtration mechanism blood
protein leaks into urine inc. pressure in blood vessel of
kidney kidney failure


DM
Nephropathy Mgmt

tight glucose control anti-hypertensives: ACE, CCB's,
alpha blockers dialysis transplant


DM
Nephropathy Prevention

control BS control BP treat UTI if
present no nephrotoxic substances dec. Na+ &
protein intakes


DM Retinopathy

DM is major cause of blindness in adults 20-74yr in US
affects almost all Type I after 20yr affects 60% of
Type II DM pts have inc. risk of cataracts
progressive, irreversible vision loss retinal
hemorrhages


DM
Retinopathy Prevention

control BS control BP no straining - use
laxatives avoid lowering head or lifting things above
shoulders get reg. eye exams to screen


DM
Retinopathy Mgmt

phocoagulation laser Tx control BP & BS
nursing - pt teach:
expected frequent eye exams usually
bilateral but uneven control BS smoking
cessation


DM Neuropathy

most common complication types: sensory-motor
polyneuropathy & autonomic neuropathy

Sensory-Motor Polyneuropathy

paresthesias: primarily lower extremities dec. deep
tendon reflexes numb feet dec. proprioception
dec. sensation unsteady gait inc. risk foot
injury


Autonomic Neuropathy


cardiovascular: tachy, ortho. hypotension, MI

GI: delayed gastric emptying, constipation, diarrhea

urinary: retention, neurogenic bladder

reproductive: male impotence

adrenal gland: hypoglycemic unawareness

pseudomotor neuropathy: no sweating, anhidrosis, dry feet


DM Neuropathy Mgmt

control BS pain control: analgesics, tricyclic
antidepressants, anticonvulsants


Other
Diabetes Complications

susceptibility to infection: combo effect of other
complications, normal inflam. response diminished, slower than
normal healing periodontal disease foot ulcers
& infections boils: furuncles, round, pus-filled
bumps cellulitis UTI yeast infections
cancer

Insulin - Onset/Peak/Duration


Rapid: O 5-10m
P
0.5-1.5h D 3-5h
Short: O 1/2-1h P 2-4h D 6-8h
Inter:
O
2h P
6-8h D
10-12h
Long: O 3h P ----- D 14-22h
Mix: O 30m P 2-8h D 24h