Acute Complx

Question 1

what are the 3 acute complx?

Answer 1

1) hyperglycemia
2) DKA (diabetic ketoacidosis)
3) HHS (hyperosmolar hyperglycemic state)

Question 2

what range is your BG if you are hypoglycemia?

Answer 2

<4mmol/L

Question 3

where is hypoglycemia more frequently seen?

Answer 3

in type 1 pts d/t insulin injections (PO insulin not used because it will be broken down by stomach enzymes due to it being a hormone and protein)

Question 4

hypoglycemia occurs if?

Answer 4

• pt receives too much insulin
• pt doesn’t eat enough (lack of CHO in diet)
• pr overexerts themselves (body uses glucose as fuel during exercise, which can deplete these stores)

Question 5

Hypoglycemia: what relies on glucose for energy?

Answer 5

neurons

Question 6

Hypoglycemia: T or F: neurons require insulin.

Answer 6

false; glucose automatically moves into RBCs and neurons without additional help)

Question 7

Hypoglycemia: what happens if adequate glucose is not supplied to neurons?

Answer 7

cerebral fx and activation of ANS is altered –> coma

Question 8

what is the Tx for hypoglycemia?

Answer 8

15g (20g if more severe) of CHO PO (eg. fruit juice, candy, chocolate)

Question 9

hypoglycemic coma

Answer 9

Loss of consciousness d/t inadequate glucose supply to neurons

Question 10

what is the Tx for hypoglycemic coma?

Answer 10

• Glucagon breaks down glycogen and releases glucose
• -> Administer 1mg glucagon SC or IM
• -> 20-50mL 50% glucose IV (eg. 50 g glucose in 100mL of water)

Question 11

DKA

Answer 11

byproduct of lipid metabolism is ketones

Question 12

why is DKA usually seen in Type 1 DM?

Answer 12

body isn’t producing enough insulin, which usually helps glucose enter cells to be used as fuel, body breaks down FA

Question 13

what are the 3 requirements for DKA?

Answer 13

• must be hyperglycemia
• requires ketosis (formation/appearance of ketones)
• metabolic acidosis (fixed acid)

Question 14

where is HHS usually seen?

Answer 14

in Type 2 DM and elderly

Question 15

T or F: HHS only occurs in Type 2 DM

Answer 15

no; can occur from other causes (ie, infection)

Question 16

HHS

Answer 16

A state of elevated blood glucose (hyperglycemia), and a high concentration
of glucose (hyperosmolar)

Question 17

what is HHS caused by?

Answer 17

• excessive CHO intake
• increased IR:
  1) presence of insulin
  2) hyperglycemia
  3) lack of a hypoglycemic
  response

Question 18

what else happens in HHS?

Answer 18

hyperosmolarity and dehydration

Question 19

remember, ketoacidosis in HHS does …

Answer 19

NOT occur because insulin is present in Type 2 DM. this means that lipolysis does not occur, so there is no excess of ketones

Question 20

severe hypoglycemia in HHS leads to…

Answer 20

1) hyperosmolarity
2) cellular efflux (glucose flows out of blood and into filtrate causing increased OP in the filtrate, pulling in
more fluid)
3) polyuria and glucosuria\
4) fluid loss
5) dehydration