Chapter 20 Diabetic Emergency Flashcards
ia condition in which there is a disturbance in the metabolism of carbs, fats, and protein
Diabetes Mellitus (DM)
What are the 3 major food sources for the body’s cells?
carbohydrates, fats, and protein
What is the primary energy source for the cell?
Carbohydrates (complex) 3 major sources 1. sucrose (table sugar) 2. lactose (milk & Dairy products) 3. starches (potatoes & Bread)
Complex carbohydrates are broken down in the body into simple sugar known as?
glucose
What percentage of glucose is used by the body?
95%
What is the major source of fuel for the cell
glucose
which cells in the body can only use glucose?
brain cells
What is the most common sign of brain cell dysfunction?
Altered mental status
What is osmotic pressure?
the glucose molecule attracts water as it moves
Why is it dangerous to give glucose to a patient with a brain injury or stroke?
when giving glucose, the brain allows more glucose to cross into the cell bringing water with it. This leads to more edema (swelling) in the brain which will worsen brain & stroke.
Why do diabetic patients become dehydrated?
glucose spills over into urine and water follows leading to dehydration
What are the two hormones that are responsible for controlling glucose?
Insulin & glucagon
What is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body.
Insulin
What are the 3 functions of insulin?
- glucose out of blood into the cell
- cause liver to take glucose out of blood and convert it to glycogen
- decreases blood glucose by action of 1&2
Does insulin facilitate the movement of glucose into the cell?
Yes, it attaches to a cell at a certain point and opens the door which allows a protein to carry glucose in.
Do insulin and glucagon have the opposite effect on blood glucose levels
Yes
INSULIN ISECREATED WHEN GLUCOSE IS HIGH AND WORKS TO DECREASE BLOOD SUGAR LEVEL BY HELPING TO MOVE GLUCOSE OUT OF THE BLOOD INTO THE CELL
GLUCAGON IS SECRETED WHEN GLUCOSE IS LOW AND WILL WORK TO INCREASE GLUCOSE LEVELS
what is glucagon’s main purpose
is to raise and maintain blood glucose levels
If glucose decrease below 70mg/dL glucagon is secreted.
what is consider a normal glucose range
80-120mg/dL
What is the range 1 hour after a person eats?
120-140mg/dL
what is BGL?
Blood Glucose level
How long can glycogen be stored in the liver?
24-48 hours
What is a glucometer?
a portable device that determines blood glucose levels of a patient
what is (mg/dL)
milligrams per deciliter
what condition is defined as a BGL of 60mg/dL or less with signs/symptoms of hypoglycemia
or
50mg/dL without signs/symptoms of hypoglycemia
Hypoglycemia
what is the primary sign of Hypoglycemia
Altered mental status
A condition defined as a BGL of greater than 120mg/dL?
Hyperglycemia
what supplies will you need to test with a glucose meter?
Glucose meter
test strips
lancet
alcohol swab
what is the primary problem of diabetes mellitus
1) a lack of insulin being secreted by the pancreas
2) the inability of the cell receptors to recognize the insulin and allow the glucose to enter at a normal rate.
what is polydipsia
frequent thirst
What is polyuria
frequent urination
what is polyphagia
hunger
what are the three Ps that alert doctors to Diabetes Mellitus
polydipsia
polyuria
polyphagia
what is type 1 diabetes?
insulin-dependent diabetes Mellitus
Type 1 diabetes occurs when the body’s own immune system destroys the insulin-producing cells of the pancreas (called beta cells).
what is type 2 diabetes?
non-insulin-dependent diabetes Mellitus
In type 1 does the pancreas secret insulin
not typically
what is the peak age for the onset of type 1
10-14 years
what is the condition that type 1 diabetics are prone?
diabetic ketoacidosis (DKA) is a life-threatening hyperglycemic condition that develops when cells in the body are unable to get the sugar (glucose) they need for energy, such as when you have diabetes and do not take enough insulin.
what happens when there is no insulin
the body cannot use sugar for energy.
When the cells do not receive sugar, the body begins to break down fat and muscle for energy. When this happens, ketones, or fatty acids, are produced and enter the bloodstream, causing the chemical imbalance (metabolic acidosis) called diabetic ketoacidosis.
If a patient presents with signs of dehydration what should you check? Why
blood glucose level
water follows glucose
increase glucose also increase the demand for what?
oxygen
What age group is most affected by Type 2 diabetes
middle age
Do type 2 patients present the three P;s
Yes, especially if the condition is untreated
what condition are type 2 diabetics prone
hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
what is hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes that is not being controlled properly, but it occurs more often in people with type 2. HHNS is usually brought on by something else, such as an illness or infection.
Diabetes is more common in what race of people
Caucasians
Hypoglycemia facts:
- more common in type 1 patients
- most dangerous complication in diabetes mellitus
- most common cause of coma in diabetic patients
why is hypoglycemia referred to as “insulin shock”
because of the shock like signs and symptoms seen with the condition which is caused by the release of epinephrine
how fast can is the onset of hypoglycemia
a few to 20 minutes
why does hypoglycemia come on so rapid
it is due to the rapid decline in brain function and secretion of epinephrine associated with a lack of glucose
what are the signs/symptoms caused by epinephrine release
diaphoresis (sweating) tremors weakness hunger tachycardia dizziness pale, cool, clammy skin warm sensation
what are the signs/symptoms caused by brain cell dysfunction
confusion drowsiness disorientation unresponsiveness seizures strokelike symptoms
why must a patient that appears to be have an altered mental status, bizarre behavior, violence, or appears intoxicated be assessed for hypoglycemia?
because alcohol inhibits the body’s ability to convert other noncarbohydrate substances into glucose during hypogycemeia
What is the emergency care for hypoglycemia?
unresponsive , unable to swallow, or unable to follow commands
- establish open airway
- SpO2 is<94 or signs of respiratory distress, hypoxia, hypoxemia, poor perfusion administer oxygen via nasal cannula
- if signs of serve hypoxia use nonrebreather mask at 15 lpm
- inadequate breathing=provide positive pressure ventilation.
- contact ALS
- Access BGL
if altered mental status, able to swallow/follow commands
- ensure patent airway
- assess BGL
- administer 1 tube glucose
What is oral glucose
gel is an over-the-counter medication, consisting primarily of dextrose and water, along with small amounts of other compounds
What are the criteria for administering oral glucose?
- altered mental status
- history of diabetes or BGL less than 50mg/dL
- has the ability to swallow
Hyperglycemic patients have to much _____in the blood and not enough________?
glucose and insulin
What is the mg/dL in diabetic ketoacidosis (DKA)
greater than 350mg/dL
What are 2 problems of DKA
dehydration
acidosis
describe the process of DKA
not enough insulin signals body that glucose is need so liver secrets glycogen but the cells still cant get the glucose so the liver metabolize fat which releases ketones (high acid) which get into the urine. The glucose and ketone attract water that goes into the urine and causes dehydrstion
what other symptoms can occur from DKS?
electrolyte imbalances that lead to cardiac disturbances
is there an early onset with DKA
No it takes several days to occur
factors that cause hyperglycemia is a DKA patient
- suffering from infection that upset inulin/glucose balance.
- inadequate dose of insulin
- taking medication such as Dilantin or steroids
- surgery, trauma, pregnancy ot heart attack
- increased carb or sugar intake
What are the signs and symptoms of
Polyuria polyphagia polydipsia nausea/vomiting poor skin turgor tachycardia rapid deep respirations fruity breath BGL greater than 350 Muscle cramps abdominal pain ( common in children) warm dry skin altered mental status coma (late stage)
is poor turgor useful to determine DKA in elderly patients? Why
NO because poor skin turgor in elderly is caused by the normal loss of skin elasticity
In DKA patient is their alerted mental status caused by the lack of glucose reaching the brain?
No its caused by dehydration, fluid shift, and acidosis
What is Kussmaul respiration
deep, rapid breathing usually as compensation for a metabolic acidosis, especially that seen with Diabetic Ketoacidosis - as a result of too much sugar in the blood
Note that at onset, it is shallow and as metabolic acidosis develops, it becomes deep and rapid. This is commonly seen in patient facing imminent death due to multiple organ failure particularly the kidneys secondary to hyperglycemia.
