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265 Diabetes/DKA

265 Diabetes

Symptoms for mild hypoglycemia BG<60;trembling,shaking, sweating,rapid HR, headache,hunger tingling of extremities,
Symptoms for Severe hypoglycemia BG<40; confusion, strange behavior, slurred speech, blurry vision, numbness, trouble concentrating, irriability, seizure, coma
What is the signifigance of beta blockers with diabetic patients? they cause less severe/obvious symptoms
examples of beta blockers Propandolol (Inderal, Dentensol)
treatment for sulfonyurea-induced hypoglycemia Diazoxide (Proglycem) or Sandostatin
Drug Treatment Hypoglycemia (patients that cannot swallow) Glucagon (IM,SUBQ, causes voimiting) with D50, if pt cant swallow (avoid extravasation)
Dawn Phenomenon nighttime release of GH that causes hypoglycemia between 5-6am--give intermediate insulin @HS
Somogyi Phenomenon morning hyperglycemia from counterregulatory response to nighttime hypoglycemia--give food@night
Sick day rules tell MD that u are sick, monitor BGq4h, test ketones when BG=240; keep taking meds, prevent dehydration,cant eat--liquids=carb content of usual meal
Sick day rules--Call MD if... Persistent N&V, mod-large ketones, BG rises after 2 doses of insulin, High temp (over 101.5) for more than 24rs
Counter regulatory hormoes Glucagon (main), GH, epinephrine, norepinephrine, cortisol
Polyuria frequent/excessive urine results from osmotic diuresis caused by excessive glucose in urine
Polydipsia excessive thirst; result of diuresis--Sodium, chloride, potassium are excreted, H20 loss is severe-->dehydration
Polyphagia cells have no glucose, starvation occurs, they will stay in starvation mode until insulin is available to move glucose into cells
Dehydration that occurs with diabetes leads to... Hemoconcentration, Hyperviscosity, hypovolemia, hypoperfusion & hypoxia
Hypoxic cells dont metaboiize glucose effectively so what occurs Kreb cycle is blocked, lactic acid increases causing more acidosis
Metabolic acidosis excess acid causes an increase in Hydrogen ions & carbon dioxide levels in blood
Kussmauls respirations increaes in rate & depth to try & get rid of CO2 & acid
metabolic acidosis ABGs show decreased pH & decreased bicarb (HCO3)
Risk factors for Metabolic syndrome FBG>100;BP>120/80;Triglyceride>150; Large waist circumference-men40, women35; decreased in HDL-men40, women-50
Interventions for Metabolic syndrome healthy heart diet (DASH); Loss of 5-10% of body wt, smoking cessaion, exercise
what do counter regulatory horomes do? inhibit isulin production--raise BG levels
Hemoglobin A1c (normal) 5.7
Hemoglobin A1c (pre-diabetic) 5.7-6.4
hemoglobin A1c (diabetes) 6.5 or higher
Alpha cell secrete Glucagon (sustains glucose when fasting)
Beta cells secrete Insulin
Delta cell secrete Somatostatin
Type I Beta cells make little/no insulin--autoimmune
Type II decreased production/utlization--increased insulin resistance
Gestational Placenta hormones need more insulin (3times); secretes excessive epinephrine &norephinreine (not enuff to stablize BG levels)
Basal insulin 24 insulin production(intermediate & long acting) Lantus, NPH, Levemir
Prandial needed during meeal (short & rapid) regular, novolog, humalong, apidra
How is diabetes diagnosed? FBG of 126 on 2 more occasion (fast 8h); 3hr glucose tolerance test--over 200
How is pre-diabetes diagnosed? FBG of 100-125; 2hr post load glucose 140-199 (fast for 10-12hrs)
What is DKA? absence/inadequate amt of insulin--results in disorders in metabolisms of carbs, fats proteins
DKA--How does body respond to insulin deficit? pulls from stored glycogen, protein & fat stores for energy
Byproduct of fatty metabolism FFA--Glycerol--Ketones(drops pH)-Metabolic acidosis
DKA--Signs & symptoms 3Ps, blurry vision, fatique, dehydation, dry mouth, itchy skin, low BP, increased HR, weakness, altered LOC, NV, abd pain, Kussmauls, coma, death
DKA--Management--drug therapy goal to lower BG by 75-150/hr; MILD-subQ Moderate to severe--reg. insulin by continous IV OR inital bolus 0.1unit/kg followed by IV insulin drip 0.1 unit/kg/hr; assess BG qhr
DKA--management--assesments 1st assess airway, LOC, hydration status, electrolytes & BG levels; Check BP,RR,HR q15min; stable--q4h; urine output, temp & LOC q1h
DKA--Fluid management 1st-1L NS over 30-60min,(2nd liter given in next half hr, restores volume & maintains perfusion) 2nd-).45%NS slowly (replaces total body fluid loss
DKA--acidosis management assess for hypokalemia; before giving IV K+ patient needs 30ml urine/hr, bicarb is used only in severe acidosis; sodium bicarb given slowly IV over several hrs pH<7 & HC03<3
DKA--signs of hypokalemia fatigue, confusio, muscle weakness, shallow res, abd distention, paralytic ileus, hypotension, weak pulse
DKA--why is bicarbonate only given in severe cases? can reverse acidosis too fast, & lead to severe hypokalemia
DKA--patient/family teaching check BG q4-6hr, check ketones, drink 3L, with nausea-liquids w/glucose & electrolytes, vomiting-8-12oz calorie free liquids, 150g of carb,
Only insulin that can be given IV regular
In acute stages insulin can be given SubQ & IM
Management of DKA (Basham) electrolyte replacement, check renal function, foley (stict I&O), ABGs (bicarb may/may not be given), EKG, correction scale
DKA--ABGs show decreased HCO3, CO2, and pH
fatty acids are used when... it is stored? glucose is not available; stored in cells
incretin hormones are secreted in response to...increases what secretion? stops what? slows what? food in tummy, increases insulin secretion, stops glucagon & slows rate of of gastric emptying
Main fuel for CNS Glucose, brain cant store/make much of it, it needs constant supply to prevent neural dysfunction & cell death
Insulin is needed to move____into cell; without it body breaksdown____ glucose; w/o it body breaks down fats/proteins
Created by: DitziDame