Block 3: Acute Complications Associated with Diabetes Flashcards
What are the acute complications with diabetes?
- Hypoglycemia
- Hyperglycemia (DKA, Hyperosmolar hyperglycemic state)
What is hypoglycemia?
Classifications
Low blood glucose < 70 mg/dl:
Level 1: Blood glucose 54-70 mg/dl
Level 2: Blood glucose < 54 mg/dl
Level 3: A severe hypoglycemic event with altered mental status requiring assistance
What sx of hypoglycemia are masked by beta-blockers?
Everything but sweating
What are the sx of first stage hypoglycemia?
ANS sx:
1. Nervous/anxiety
2. Sweating
3. Hunger
4. N
5. Angina
6. Irritability
7. Tachycardia
What are the sx of second stage hypoglycemia?
CNS sx:
1. Weakness/fatigue
2. Mental impairment
3. Dizziness
4. HA
5. Drowsiness
6. Loss of coordination
7. Coma, seizure, death
What are the causes of hypoglycemia?
- Missed or delayed meals
- Vomiting
- Decreased carbohydrate intake
- Increased physical activity
- Menstruation (decreased progesterone) -> decreased insulin
- Inaccurate blood glucose monitoring results -> too much insulin
Who are at risk for asymtomatic hypoglycemia?
- Elderly
- Advanced neuropathy
- Beta-blockers
What are the tx of mild hypoglycemia?
Test blood glucose if possible:
* Low blood glucose < 70 mg/dl
If low treat with 15 grams of carbohydrates; repeat if needed:
* 3 glucose tablets
* OTC glucose gel
* ½ cup of fruit juice or regular soda
* 1 cup of milk
* 5 pieces of hard candy
* 3 tsp. of table sugar
* 1 TBS of honey
Avoid chocolate, contains fat that slows the absorbtion of carbs
What do you do after administering 15 g of carbs?
- Recheck BG 15 minutes after tx
- If blood glucose is still low, or if symptoms persist, retreat
- After blood glucose >70 mg/dl patient should eat small carbohydrate snack to prevent recurrent event
What is the tx for severe hypoglycemia?
Usually needs assistance from someone for treatment:
1. Dextrose 50% IV 50 ml (25 gm)
2. Glucagon Dry Powder (NS): 3 mg spray in 1 nostril
2. Glucagon Injection Kit or Autoinjector (IV, IM or SC)
* Adults: 1 mg
* Children 0.25-0.5 mg
Whta is hyperglycemia?
Blood glucose > 130 mg/dl fasting
Blood glucose > 180 mg/dl within 2 hours after meals
What are the sx of hyperglycemia?
- Extreme thirst
- Hunger
- Dry skin
- Frequent urination
- Blurred vision
- Drosiness
- N
What are the causes of hyperglycemia?
- Food
- Emotional stress
- Physical stress
- Lack of normal exercise
- Inadequate diabetes medication regimen
- Use of improperly stored insulin
What are the general guidelines for mild hyperglycemai tx?
- ALter med regimen
- Drink plenty of sugar-free fluids
- Lifestyle mod: dietary changes, increase physical activity
What do you do if a patient comes and you’re unsure if they are Hypo- or Hyperglycemia?
Assume the patient has
HYPOglycemia
What is the somogyi effect?
Rebound hyperglycemia:
Bedtime glucose is normal -> Low glucose during 2-3AM -> hyperglycemia in AM
What are the nocturnal sx of somogyi? Tx?
- Nightmares
- Sweating
- Hunger
- Headache
Need to decrease insulin dose to prevent nocturnal HYPOglycemia
What is dawn phenomenon?
Morning HYPERglycemia:
Bedtime glucose is normal -> Normal glucose during 2-3AM -> hyperglycemia in AM
Sx of dawn phenomenon? Tx?
May see small increase in glucose levels in the early morning (4 to 8 AM)
Need to increase insulin dose
What are the complications of severe hyperglycemia?
- DKA
- Hyperosmolar Hyperglycemic Non-ketotic Syndrome (HNS)
Both Can Be Life Threatening
What is the cause of DKA?
T1DM mostly:
Severe insulin deficiency -> body can’t use glucose -> FA used as fuel -> ketones build up in the body
What are the sx of DKA?
- Hyperglycemia (not extremely high)
- 3 Ps
- HA, fatigue
- Dehydration
- Acetone breath -> Kussmaul breathing
- Ketonuria
- N/V
What are the clinical tx of DKA?
IV fluids: replace fluids is required
Insulin: Correction of HYPERglycemia and ketosis with insulin will be required (slowly); continue until ketones are (-) and anion gap closes
Potassium: correction of any electrolyte imbalances, especially K and P may be needed, K will likely be needed
Bicarb: Possible contraindication; use only if pH < 6.9
How do you monitor DKA?
Plasma glucose falls more rapidly than ketones:
* Do NOT stop insulin until reversal of ketosis occurs.
Use the pH and anion gap to assess response, not glucose and ketones:
* Normal anion gap: 8-12 mEq/L
* A high anion gap indicates that there is loss of HCO3- without a concurrent increase in Cl- to compensate for increased metabolic acidosis
How do you calculate anion gap?
Anion gap = cations-anions
Anion gap= ([Na+] - [Cl- + HCO3-])
What is HNS?
T2DM mostly:
The amount of insulin produced and/or medications are not adequate for the body’s needs form prolonged hyperglycemia
Stress
What is sx of HHS?
- Severe hyperglycemia
- 3 Ps
- Severe dehydration
- Weakness
- Leg cramps
- Impaired vision
- Mental changes
- HYPOtension
- Tachycardia
What is the tx of HHS?
IV fluids: replace of fluids required
Insulin:Correction of HYPERglycemia with insulin will be required
Potassium: Correction of any electrolyte imbalances, especially K and Phos may be needed; K will likely be needed
