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DIABETES COMBINED
| Question | Answer |
|---|---|
| cause of ketoacidosis | not taking insulin |
| TX for unconscious pt | dextrose IV or glucagon IM |
| glucose levels (normal) | 70-105 |
| fasting glucose level | 110-125 |
| 2 hr postprandial glucose test | greater than 200 confirms diabetes |
| TX for Ketoacidosis | treat dehydration, electrolyte imbalance, acidosis and hyperglycemia |
| TX - Dehydration | replace fluid loss with NORMAL SALINE. 1000ccc 1st hr, can be f/ w up to 8000cc fluid in the 1st 24 hrs |
| TX - Electrolytes | PRIMARY CONCERN IS K+. Fluid replacement 1st then K+ after urine output is ok. Give potassium alloguots 10-20 MEQ IV. |
| TX - Acidosis | slow infusion INSULIN DRIP. Once BS is down to 250-300, add dextrose to IV. Potential of HYPOGLYCEMIA (TX is to add sugar to IV to even out). Monitor ABG and ketones |
| S/S of HYPERGLYCEMIA | 3P'S: polyuria, polyphagia, polydypsia. Nausea, drowsiness, blurred vision, dry skin |
| S/S of HYPOGLYCEMIA | shaking, rapid heart beat, headache, sweating, impaired vision, dizziness, hunger, weakness, fatigue, anxious, irritable |
| DIABETES MNEMONICS | HOT & DRY = SUGAR HIGH; COLD & CLAMMY = NEED SOME CANDY |
| DIABETES MNEMONICS (HYPOGLYCEMIA) | TIRED. Tachycardia, irritability, restless, excessive hunger, diaphoresis depression |
| TX hypoglycemia | check blood sugar, drink OJ, check blood sugar, within 30 mins, eat pb sandwich or meat sandwich & a glass of milk. |
| DIABETES MNEMONICS (Diabetec Ketoacidosis) - tx | HIE (hydration insulin electrolyte replacement) |
| Classic sign of KETOACIDOSIS | KUSSMAUL RESPIRATIONS (rapid and deep) & Fruityr breath odor |
| DIABETES MELLITUS | is a chronic metabolic disorder in which glucose intolerance results from varying degrees of insulin insufficiency. |
| DIABETES TYPE 1 | INSULIN DEPENDENT, JUVENILE-ONSET. Charac by ABSENCE of endogenous insulin. Requires EXOGENOUS insulin rest of life |
| DIABETES TYPE 2 | NON INSULIN DEPENDENT. Charac by INADEQUATE insulin. May be controlled by exercise and diet but may req oral hypoglycemic |
| ISLETS OF LANGERHANS | blood glucose normally regulated by insulin which is produced by this in the pancreas |
| PRIMARY GOAL IN TX DIABETES | maintain and stabilize glucose levels |
| INSULIN | promotes the transportation of glucose into cells and influences metabolism of fats and proteins. |
| HYPOGLYCEMIA - CAUSES | too little food, too much insulin or diabetes med, too much physical activity. |
| HYPOGLYCEMIA - ONSET | SUDDEN, may progress to insulin shock!!! BS is beow 70 |
| HYPERGLYCEMIA - CAUSES | too much carbs, not enough meds, illness or stress |
| HYPERGLYCEMIA - ONSET | GRADUAL, may progress to diabetic coma, BS is above 180 |
| HHNKS - cause | TPN & Dialysis |
| HHNKS - s/s | no ketones but BS greater than 600 |
| HYPOGLYCEMIA TX - awake | feed 15g carbs ex milk |
| HYPOGLYCEMIA TX - unconscious | IV dextrose or IM glucagon 1mg. Once conscious, feed |
| EXERCISE for diabetics | decrease need for insulin due to muscle is sensitive to fat/insulin |
| ILLNESS for diabetics | check BS freq. hydrate/fluids, check urine for KETONES |
| FYI | diabetics need to eat at reg intervals to stabilize/maintain BS |
| alcohol choices for diabetic pts | wine or light beer |
| SOMOGYI PHENOMENON | hypo at night and hyper in AM. Checking BS @2am; if less than 60, then pt is confirmed. TX: bedtime snack and decreased insulin |
| DAWN PHENOMENON | NOT RELATED TO HYPOGLYCEMIA. AM = elevated BS. BS is normal between 2-3am. PT becomes hyperglycemic probably due to REM Sleep. TX: give insulin later at night and bedtime snack. |
| PREVENTING COMPLICATIONS | ABC = A1C (LESS THAN 6.5) B= BP (SYSTOLIC LESS THAN 130, DIASTOLIC LESS THAN 80) C=CHOLESTEROL (LESS THAN 200) |
| CARDIOVASCULAR COMPLICATIONS | increased Triglycerides & fatty acids as a result of thick blood |
| DIABETIC NEUROPATHY | no feeling or painful |
| BEST TEST: | MONITOR BS Q3M. A1C LESS THAN 6.5 TO PREVENT COMPLICATIONS |
| AVOID EXERCISE | IF BS IS GREATER THAN 250 OR LESS THAN 100 |
| BEST PREDICTOR OF COMPLICATIONS | POOR GLYCEMIC CONTROL |
| DRAWING UP INSULIN | DO NOT MIX. 1ST IS REG. NO NPH IN REGULAR |
| MACROVASCULAR | CAD (Coronary artery disease), CVA (Cerebral Vascular Accidents), PVD (Peripheral Vascular Disease) |
| NEUROPATHIC TX | normalize blood glucose, normalize serum lipids, normalize body weight |
| EXERCISE | TYPE 1 - may experience HYPERGLYCEMIA. TYPE 2 - may experience HYPOGLYCEMIA |
| INSULIN MIXING | CLEAR TO CLOUDY. Humulin N is cloudy, Humulin R is clear so draw regular first |
| FYI INSULIN | all rapid acting and short acting insulins are clear |
| LIPOHYPERTROPHY | swelling or bumps |
| LIPOATROPHY | hollowing or pitting of subcutaneous tissue |
| LIPODYSTROPHY | painful injection resulting from cold insulin |
Created by:
jekjes
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