Assessment and Management of Diabetes Complications (Part 3)

Question 1

complications of diabetes

Answer 1

hypoglycemia
diabetic ketoacidosis
HHS
long term

Question 2

hypoglycemia numbers

Answer 2

below 70

Question 3

severe hypoglycemia number

Answer 3

less than 40

Question 4

clinical manifestations of hypoglycemia
- mild

Answer 4

SNS stimulation
sweating
tremor
tachycardia
palpations
nervousness
hunger

Question 5

clinical manifestations of hypoglycemia
- moderate

Answer 5

brain deprived of glucose
CNS symptoms
inability to concentrate
headache
light headedness
confusion
memory lapse
numbness of lips and tongue

Question 6

clinical manifestations of hypoglycemia
- severe

Answer 6

disorientation
seizure
difficulty arousing from sleep
loss of consciousness

Question 7

can patients fix their own severe hypoglycemia

Answer 7

no
they require assistance from other people

Question 8

who might have variable response to mild hypoglycemic

Answer 8

elderly
beta blocker
long term diabetic

Question 9

management of hypoglycemia
- able to eat

Answer 9

check BS first
15g of carbs
repeat BS in 15 min
15 g of carb and protein

Question 10

management of hypoglycemia
- unable to eat
- community setting

Answer 10

glucagon 1mg IM/SQ

Question 11

management of hypoglycemia
- unable to eat
- acute care

Answer 11

25-50ml of 50% dextrose IV push
amp of D50

Question 12

what do we need to be careful about after giving D50

Answer 12

careful assessment of IV site prior to administration and after due to dextrose

Question 13

DKA definition

Answer 13

absence or markedly inadequate amount of insulin resulting in disorders of the metabolism of carbs, proteins, and fats

Question 14

DKA
- clinical manifestations

Answer 14

hyperglycemia (300-800)
metabolic acidosis
severe dehydration
electrolyte losses
ketone in blood/urine
kussmual
acetone breath
3 P
altered mental status

Question 15

DKA onset

Answer 15

rapid

Question 16

common causes of DKA

Answer 16

missed insulin dose
illness
infection
undiagnosed/untreated diabetes

Question 17

DKA assessment findings

Answer 17

blood glucose levels 300-800
low pH, CO2, and bicarb
ketones in urine/blood
electrolyte abnormalities
elevated BUN/cr and HCT

Question 18

DKA what electrolyte is affected

Answer 18

K

Question 19

steps to treating DKA

Answer 19

rehydration first
then insulin
then electrolyte

Question 20

rehydration step of DKA treatment

Answer 20

0.9NS initially, then 0.45 few fours in, then D5W when BS is about 250-300

Question 21

who might we use .45 fluids with during first step of treating DKA

Answer 21

hypertensive
heart failure

Question 22

how many total liters should a DKA patient get

Answer 22

6-10

Question 23

steps of treating DKA insulin

Answer 23

continuous infusion of regular insulin
frequent BS monitoring
IV solution D5 when blood sugar is 250-300

Question 24

electrolyte replacement DKA

Answer 24

cautious but timely replacement of K

Question 25

why might we not treat K right away

Answer 25

because K moves out as blood sugar rises so if we fix blood sugar then K will fix itself

Question 26

HHS defintion

Answer 26

metabolic disorder of type 2 resulting from relative insulin deficiency initiated by illness that raises the demand for insulin. More common in older adults

Question 27

HHS clinical manifesations

Answer 27

slow onset hyperglycemia (BS>600) absence of ketones

Question 28

do HHS have metabolic acidosis

Answer 28

NO

Question 29

HHS assessment and diagnostic findings

Answer 29

BS level 600-1200 osmolality greater than 320 BUN dehydrated(elevated)

Question 30

HHS treatment

Answer 30

similar to DKA - rehydration with IV fluids - insulin replacement - electrolyte replacements

Question 31

long term complications with diabetes

Answer 31

microvascular macrovascular neuropathic

Question 32

macrovascualr complications of diabetes

Answer 32

accelerated atherosclerotic changes coronary artery disease cerebrovascular disease peripheral vascular disease

Question 33

microvascular complications of diabetes

Answer 33

diabetic retinopathy nephropathy

Question 34

neuropathic complications of diabetes

Answer 34

perhierphal neruopathy autonomic neuropathies hypoglycemia unawarness meticulous foot care

Question 35

what does autonomic neuropathy cause

Answer 35

lack of adrenergic response

Question 36

foot care of a diabetic

Answer 36

have podiatrist check feet at least once a year file toenails check feet daily wash feet daily keep skin soft do not walk barefoot protect feet from hot and cold

Question 37

steps to lower risk of diabetic complications

Answer 37

A1C less than 7 take care of your feet get recommended screenings and early treatment for complications quit smoking