ch 37 key points

Question 1

diabetes: disturbance in glucose metabolism

• type 1: appears at a young age, patient requires insulin for life
• type 2: usually develops later in life, managed with OHA (oral hyperglycemic agents), lifestyle adjustments, & insulin

the goal in diabetes tx is to maintain blood glucose & lipid levels WNL, A1c below 6.5%, and prevent complications

Question 2

• emotional & physical stress, illness, & surgery can increase blood glucose level and requires insulin adjustments
• basal insulin is the amount that would be normally produced throughout the day
• bolus/correction dose: rapid or short acting insulin to manage elevations and bring next level into range
• DKA occurs in type 1 & is a serious condition: incomplete metabolism of fats marked by absence of insulin [causes metabolic acidosis, dehydration, hypovolemia & electrolyte imbalances. IV fluids and insulin is given for treatment]
• HHS occurs in type 2 & is caused by stress or illness. [levels are often between 600-1000 and causes severe dehydration]
• hypoglycemia: caused by too much insulin or too much exercise. ALWAYS give a snack after insulin and the PRIORITY is to monitor for hypoglycemia.
• if there is any doubt whether the patient has hypo or hyper glycemia, ALWAYS treat for HYPOglycemia
• long term consequences: damage to blood vessels, cardiovascular disease, neuropathy, nephropathy, retinopathy, PVD