class 8 diabetes Flashcards
what is diabetes mellitus
a metabolic disorder characterized by the presence of hyperglycemia due to:
1. the impairment of insulin secretion, defective insulin production, action, or both
2. inefficient utilization of insulin in the body (insulin resistance
0
what happens if there is beta cell destruction in DM
absolute insulin deficiency
classic symptoms of DM
polyuria, polydipsia, polyphagia (3 p’s), unexplained weight loss
controllable risk factors for DM
sedentary lifestyle
obesity
uncontrollable risk factors for DM
-family hx
-race
-autoimmune
-metabolic conditons
-HTN
tx for type 1
insulin
tx for type 2
lifestyle
po hypoglycemic
insulin as a last line
tx for prediabetes
education & lifestyle
3 things to minimize complications
-early screening
-intervention
-optimization of glycemic control
what is prediabetes
a condition where blood sugar levels are higher than normal, but are not yet high enough to be diagnosed as type 2 diabetes
-they may not go on to develop diabetes
how does DKA develop
when there is no insulin to use blood glucose for energy the body breaks down fat stores to get energy when creates ketones
age of onset for DM1
any age
peak incidence is age 10-15
age of onset DM2
over 30/any age
increasing rates in children
symptoms of DM1
abrupt
-3 p’s: polyuria, polydipsia, polyphagia
-fatigue
-weight loss
symptoms of DM2
frequently none, gradual & vague
-s/s of glucose intolerance
-fatigue
-recurrent infections (^B/G=immune dysfunction)
ketosis in DM1
can occur often
DKA
ketosis in DM2
very rare
can experience HHNS
management of DM1
insulin
management of DM2
lifestyle mod
may need oral hypoglycemics
insulin if necessary (last resort)
normal fasting b/g in adults
4-7
normal fasting b/g in kids
4-8
hypoglycemia=
<4
critical hypoglycemia
<2.8
lab results for diagnosis of DM
-fasting plasma glucose (pg) >=7
-2h pg in a 75g OGTT >=11.1
-random pg >11.1
-HbgA1C: over 7 adults, 7.5 kids
HbgA1C: prediabetes
6.0-6.4
what is HbgA1C
measures the % of RBC’s that are coated in glucose over a 120 day period
HbgA1c; # predict the development of retinopathy
6.5 or greater
how often should HbgA1C be taken if blood glucose targets are not being met/making changes to management
every 3 months
factors that can alter HbgA1c:
anything that affects RBC’s
-age
-chronic conditions that affect RBC production
-dec EPO
-iron def anemia
nonpharm management of type 1 and 2
diet
exercise
maintaining a healthy weight
regular screening for complications
potential causes of diabetes in ages 5-7
stress of school
inc exposure to infectious disease
potential causes of diabetes in ages 11-13
puberty
rapid growth
inc emotional stress
insulin antagonism of sex hormones
why is diabetes difficult to manage in children
-growing (spurts and plateaus)
-energy expenditure (irregular)
-varying nutritional needs (irregular)
-psychosocial impacts (diagnosis, puberty, resentment)
signs and symptoms of hypoglycemia
-reduced cognition
-tremors
-diaphoresis
-weakness
-hunger
-headache
-irritability
-seizure
signs of hyperglycemia
-3 p’s
-dehydration
-fatigue
-fruity breath
-kussmaul breathing
-weight loss
-hunger
-poor wound healing
hypoglycemia treatment
-early detection is key
-if conscious give carbs/glucose tabs
-pt should have usual meal or snack once b/d is safe
-if normal meal is >1h away, 15g of carbs and a protein should be given
-pt should not be encouraged to change normal eating schedules when low/high, just correct then continue with normal meals/snacks
tx of hypo in <5yr
5g carbs
(40ml juice/soda/sweet drink, 2 dextrose tabs)
tx of hypo 5-10 yr
10g carbs
(85ml juice/soda/sweet drink, 3 dex tabs)
tx hypo >10 yr
15g carbs
(125ml juice/soda/sweet drink, 5 dex tabs)
tx of critical hypo in hospital
0.5-1g/kg of 50% dextrose IV over 1-3 minutes followed by continuous infusion
home management of unconscious critical hypo in <=5 yrs
0.5mg glucagon subcut or IM
home management of unconscious critical hypo in >5 yrs
1 mg glucagon subcut or IM
what causes DKA
absolute deficiency of insulin (very hyperglycemic)
onset of DKA (dm1)
sudden
symptoms of DKA (dm1)
ketosis
kussmaul breathing
“fruity” breath
dehydration
electrolyte loss
serum glucose in DKA (dm1)
> 13.9mmol/L
serum ketones in DKA (dm1)
positive
arterial pH in DKA (dm1)
<7.3 (metabolic acidosis)
urine ketones in DKA (dm1)
positive
onset of HHNS (DM2)
gradual (inc mortality d/t going undetected)
symptoms of HHNS (DM2)
neurological symptoms
dehydration
electrolyte loss
serum glucose in HHNS (DM2)
> 33.3mmol/L
serum ketones in HHNS (DM2)
negative
arterial pH in HHNS (DM2)
7.35-7.45
urine ketones in HHNS (DM2)
negative
priority with DKA pt’s
1: ABC’s
2: IV fluids (isotonic w insulin drip at very slow rate d/t potassium)
neuro assessment
BG Q1H
ABG’s, lytes
EKG
I&O (foley)
tx source (ABX)
transition to subcut insulin when well
what is Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
-hyperglycemia that occurs without ketosis and acidosis
-typical in type 2 diabetes
-treatment includes insulin admin, fluid replacement & correction of electrolyte imbalances
long term complications: macrovascular
-coronary artery disease
-cerebrovascular disease
-peripheral vascular disease
long term complications: micro vascular
-retinopathy
-nephropathy
-neuropathy
complication: retinopathy
rupture of microvascular (viterous hemorrhage) and aneurysms in the retina
-causes sudden blurred vision
-can lead to retinal detachment and cataracts
clinical manifestations of nephropathy
-albuminuria (d/t kidney damage)
-fatigue
-thirst
-anemia (dec EPO d/t dec kidney func)
-weight loss
-frequent UTI’s
s&s of nephropathy
-swollen periphery
-nausea & loss
-fatigue/insomnia
-dry/itchy skin
-difficulty concentrating
clinical manifestations peripheral neuropathy
tingling, prickling, burning
-leads to total numbness
clinical manifestations of autonomic neuropathies
-cardiac (silent, painless, ischemia), GI, & renal systems (subjective to UTI’s)
clinical manifestations of sudomotor neuropathy
-dry feet; cracks->ulcers
-profuse sweating up top
foot & leg symptoms neuropathy
-dry cracked, scaly feet, diabetic ulcers
-peripheral vascular disease
-immunocompromise
-takes 10-15 years to develop these complications
diabetes and mental health
-stressful
-financial burden
-fear of complications/life implications
-stigma
-lifestyle management
hospital & community nursing care
-skin assessment
-neurovascular assessment
-monitor B/G
-prevent infection
-education
-medication adherence
-administer insulin (if necessary)
-mental health/psychosocial assesment regularly
patient education
-about disease
-insulin therapy and technique
-self monitoring B/G
-nutriton
-urine testing
-lifestyle
nutrition and activity
-match insulin to carb intake
-individualized
-encourage activity
-have carb snack on had all the time
influences on blood glucose
-illness & infection (inc)
-excercise (dec)
-diet
-alcohol (dec)
-stress (inc)
insulin syringe guidelines
-4-8mm needle
-re-suspension of cloudy insulin
-subcut: 45-90 degree angle
-site rotation
insulin pen guidelines
-dial
-prime with 2 units
-hold for at least 10 secs in
-site rotation
insulin pump therapy
-continous subcut line
-can bolus for meals
-small amt of insulin administered 24/7 to mimic pancreas
common insulin pump problems
-site not working
-tubing blocked, torn or leaking
-air in tubing
-reservoir empty
-not changing sites every 3 days
implications for nursing
-regular assessment for LT complications
-assess impact on mental health
-education
-promote self-management
-engage in public awareness campaigns
-early detection is critical
-advocacy efforts to improve access to resource
