Complex Exam 4 - metabolism: diabetes Flashcards
What type of diabetes does DKA occur with?
Type 1
What is the blood glucose level with DKA?
> 300 mg/dL
What can metabolic acidosis lead to with DKA?
coma
What is present in the blood and urine with DKA?
ketones
What is the onset of DKA?
- rapid
- 48-72 hours
Do the 3 P’s occur with DKA?
yes
What type of respirations occur with DKA?
kussmaul
When is fruity breath present?
DKA
What neurological changes can occur with DKA?
- blurred vision
- HA
- weakness
- ortho hypo
- mental status changes
What GI manifestations occur with DKA?
- weight LOSS
- N/V
- GI pain
Why would cerebral edema occur with DKA or HHS?
if fluids are given too quickly
What F&E imbalances can occur with DKA and HHS?
- hypokalemia
- hypoglycemia
- hypovolemia (dehydration)
How is insulin given for DKA?
via drip
When is 1/2 D5 added to NS with DKA and HHS?
when blood glucose reaches 250
When is potassium added to the drip with DKA?
if hypokalemia occurs
How should glucose levels be brought down with DKA?
slowly
How often should blood glucose levels be checked with DKA?
hourly
How should insulin be given once a DKA patient is stable?
sliding scale SQ
What happens to potassium levels with DKA?
- initially elevated
- decreased with treatment
Why are BUN and creatinine increased with DKA?
dehydration
What type of diabetes does HHS occur with?
Type 2
What is the blood glucose level with HHS?
> 600 mg/dL
Are ketones present with HHS?
no
Who is at the highest risk for HHS?
older adults aged 50-70 with a mortality rate of 40-70%
What medications can cause HHS?
- glucocorticoids
- thiazide diuretics
- phenytoin
- beta blockers
- calcium channel blockers
What can lack in the body that can cause HHS?
- insulin
- fluids
- kidney function
What can be present in the body that can cause HHS?
- MI
- cerebral vascular injury
- sepsis
- infection
- stress
Can HHS cause the 3 p’s?
yes
What can dehydration cause with HHS?
- blurred vision
- HA
- weakness
What can an increased osmolarity (>350) cause with HHS?
- seizures
- myoclonic jerking
What can occur with HHS but is reversible?
- paralysis
- coma
At what osmolarity do neurological deficits occur?
> 315
What follows rapid isotonic fluid replacement with HHS?
hypotonic fluids (0.45% NS)
How is insulin given with HHS?
- start with 0.1-0.15 unit/kg IV bolus
- follow with 0.1 unit/kg/hr continuous infusion
If an HHS patient experiences acidosis, what should be given?
sodium bicarbonate with potassium by slow IV infusion
How can the risk of dehydration be reduced with HHS?
- fluid intake of 2-3 L/day
- consume sugar for low BG
How often should blood glucose be monitored with HHS?
q 4 h
What should be given to a patient with HHS if they cannot tolerate solid food?
liquids with carbs and electrolytes (sports drink)
When should the provider be notified with HHS?
- ill longer than 24 hours
- BG > 250
- inability to tolerate foods/liquids
- ketones in the urine for more than 24 hours
- temp of 101.5 for 24 hours
What are the characteristics of the skin with hypoglycemia?
- cool
- clammy
- sweaty
What are other signs/symptoms of hypoglycemia?
- shakiness
- confusion
- palpitations
- HA
- lack of coordination
- blurred vision
- seizures, coma
What blood glucose occurs with hypoglycemia?
< 70
What should be given to a conscious hypoglycemic patient?
15-20 g carbs
What should be done 15 minutes after giving carbs to a conscious hypoglycemic patient?
- recheck blood glucose
- give a carb and a protein
What are examples of things you can give to a conscious hypoglycemic patient?
- 4-6 oz fruit juice or soft drink
- glucose tablets or gel
- 6-10 hard candies
- 1 tbsp honey
What should be given to a hypoglycemic patient who is unconscious or unable to swallow?
glucagon SQ or IM or 50 % dextrose if available
