Assessment and Management of Diabetes Complications (Part 3) Flashcards
complications of diabetes
hypoglycemia
diabetic ketoacidosis
HHS
long term
hypoglycemia numbers
below 70
severe hypoglycemia number
less than 40
clinical manifestations of hypoglycemia
- mild
SNS stimulation
sweating
tremor
tachycardia
palpations
nervousness
hunger
clinical manifestations of hypoglycemia
- moderate
brain deprived of glucose
CNS symptoms
inability to concentrate
headache
light headedness
confusion
memory lapse
numbness of lips and tongue
clinical manifestations of hypoglycemia
- severe
disorientation
seizure
difficulty arousing from sleep
loss of consciousness
can patients fix their own severe hypoglycemia
no
they require assistance from other people
who might have variable response to mild hypoglycemic
elderly
beta blocker
long term diabetic
management of hypoglycemia
- able to eat
check BS first
15g of carbs
repeat BS in 15 min
15 g of carb and protein
management of hypoglycemia
- unable to eat
- community setting
glucagon 1mg IM/SQ
management of hypoglycemia
- unable to eat
- acute care
25-50ml of 50% dextrose IV push
amp of D50
what do we need to be careful about after giving D50
careful assessment of IV site prior to administration and after due to dextrose
DKA definition
absence or markedly inadequate amount of insulin resulting in disorders of the metabolism of carbs, proteins, and fats
DKA
- clinical manifestations
hyperglycemia (300-800)
metabolic acidosis
severe dehydration
electrolyte losses
ketone in blood/urine
kussmual
acetone breath
3 P
altered mental status
DKA onset
rapid
common causes of DKA
missed insulin dose
illness
infection
undiagnosed/untreated diabetes
DKA assessment findings
blood glucose levels 300-800
low pH, CO2, and bicarb
ketones in urine/blood
electrolyte abnormalities
elevated BUN/cr and HCT
DKA what electrolyte is affected
K
steps to treating DKA
rehydration first
then insulin
then electrolyte
rehydration step of DKA treatment
0.9NS initially, then 0.45 few fours in, then D5W when BS is about 250-300
who might we use .45 fluids with during first step of treating DKA
hypertensive
heart failure
how many total liters should a DKA patient get
6-10
steps of treating DKA insulin
continuous infusion of regular insulin
frequent BS monitoring
IV solution D5 when blood sugar is 250-300
electrolyte replacement DKA
cautious but timely replacement of K
why might we not treat K right away
because K moves out as blood sugar rises so if we fix blood sugar then K will fix itself
HHS defintion
metabolic disorder of type 2 resulting from relative insulin deficiency initiated by illness that raises the demand for insulin. More common in older adults
HHS clinical manifesations
slow onset
hyperglycemia (BS>600)
absence of ketones
do HHS have metabolic acidosis
NO
HHS assessment and diagnostic findings
BS level 600-1200
osmolality greater than 320
BUN dehydrated(elevated)
HHS treatment
similar to DKA
- rehydration with IV fluids
- insulin replacement
- electrolyte replacements
long term complications with diabetes
microvascular
macrovascular
neuropathic
macrovascualr complications of diabetes
accelerated atherosclerotic changes
coronary artery disease
cerebrovascular disease
peripheral vascular disease
microvascular complications of diabetes
diabetic retinopathy
nephropathy
neuropathic complications of diabetes
perhierphal neruopathy
autonomic neuropathies
hypoglycemia unawarness
meticulous foot care
what does autonomic neuropathy cause
lack of adrenergic response
foot care of a diabetic
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
steps to lower risk of diabetic complications
A1C less than 7
take care of your feet
get recommended screenings and early treatment for complications
quit smoking
