Chapter 20 Flashcards
Diabetes mellitus
disease that frequently causes changes in the patient’s mental status resulting from alterations in the blood glucose (blood sugar) level
what can follow a glucose molecule
water
insulin
hormone secreted by pancreas that lowers BG levels by promoting movement of glucose from the blood into cells
Insulin main functions
It increases the movement of glucose out of the blood and into the cells.
It causes the liver to take glucose out of the blood and convert it into glycogen, the stored form of glucose.
It decreases the blood glucose level by the actions just listed: facilitating the movement of the glucose out of the blood and into the cells and the liver.
glucagon
hormone secreted by the pancreas that raises BG levels by stimulating the liver to convert stored glycogen into glucose
major functions of glucagon
It converts glycogen stored in the liver back into glucose and releases it into the blood.
It converts other, noncarbohydrate substances into glucose in the liver.
It increases and maintains the blood glucose level by the actions just listed: converting glycogen and other substances into glucose.
Which hormone is released and causes s/s during hypoglycemia
Many of the signs you see in a patient with a low blood glucose level are caused by epinephrine.
Normal BG Level
70-140mg/DL
glucose regulation cycle
eat a meal: BG goes up
BG goes up: insulin secreted
Insuline Secreted: BG goes down
Glucagon Secreted: BG goes up/maintains
how much glucose after a meal is converted to glycogen
2/3
hypoglycemia
typically defined as a BGL of 70 mg/dL or less with signs or symptoms of hypoglycemia.
more common in type 1
hyperglycemia
defined as a BGL greater than 200 mg/dL
Type 1 diabetes
patients pancreas does not secrete or produce insulin
type 2 diabetes
pancreas produces insulin but is not effective in controlling in the BG level, does not usually require pt to take insulin, can be regulated via diet, exercise, and medication.
more common than type 1
the three ps for diabetes
polydipsia- frequent thirst
polyuria- frequent urination
polyphagia- frequent hunger
diabetic ketoacidosis DKA
more common in type 1
excessively high BG level and extremely low insulin level, causes glucose to be excreted, produces ketones and acidic environment
hyperglycemic hyperosmolar syndrome (HHS)
more common in type 2
excessive high BG level causes loss of large amount of fluid from glucose spilling into urine
leads to severe dehydration and AMS
type 1 diabetics potential causes for hypoglycemia
The patient takes his insulin and does not eat a meal.
The patient takes his insulin, eats a meal, but drastically increases his activity beyond normal.
The patient takes too much insulin—either takes too much at one time or forgets and takes an extra dose
hypoglycemia s/s from epi release
Diaphoresis (sweating)
Tremors
Weakness
Hunger
Tachycardia (increased heart rate)
Dizziness
Pale, cool, clammy skin
Warm sensation
hypoglycemia s/s from brain cell dysfunction
Confusion
Drowsiness
Disorientation
Unresponsiveness
Seizures (can occur in severe cases)
Stroke-like symptoms including hemiparesis (especially in the elderly)
factors that could cause hyperglycemia in a DKA pt
infection like a UTI or pneumonia
inadequate dose of insulin/medication
medications such as thiazide, Dilantin, or steroids.
recent cocaine use
stress such as surgery, trauma, pregnancy, or acute medical illness such as heart attack or stroke
change in diet that overload carbs/sugars
s/s dka
Three Ps
Nausea and vomiting
Poor skin turgor
Tachycardia
Rapid deep respirations (called Kussmaul respirations)
Fruity or acetone odor on the breath
Positive orthostatic tilt test
BGL > 350
Muscle cramps
Abdominal pain (in 50 percent of patients; more common in children with DKA)
Warm, dry, flushed skin
Altered mental status
Coma (very late)
Kussmaul Breathing
pattern of deep and rapid breathing in bodys attempt to blow off acid
S/S of HHS
Tachycardia
Fever
Positive orthostatic tilt test
Dehydration
Thirst (polydipsia)
Dizziness
Poor skin turgor
Altered mental status
Confusion
Weakness
Dry oral mucosa
Dry, warm skin
Polyuria (if dehydrated, the urine output will be scanty [oliguria])
Nausea and vomiting
s/s of AMS with diabetic history
Rapid onset of an altered mental status after missing or vomiting a meal, unusual exercise, or physical work
Intoxicated appearance—from staggering or slurred speech to complete unresponsiveness
Tachycardia (elevated heart rate)
Cool, moist skin
Hunger
Seizure activity
Uncharacteristic or bizarre behavior, combativeness
Anxiousness or restlessness
Bruising at insulin injection sites on the abdomen
Blood glucose reading of < 70
