Complications of Glucose Disorders

Question 1

• High, high glucose; body uses fatty acids for fuel producing ketone bodies
• Tachypnea, fruity breath, hypotension/tachycardia, abd pain, n/v drowsiness
• Sugar >250, acidic (pH

Answer 1

DKA

Question 2

• Like DKA but w/o acidosis (ketosis)
• Most common in DM2. MI, infx, CVA, or recent surgery often precipitates
• Insidious onset, weakness, polyuria, polydipsia, lethargy/confusion, dehydration, Kussmaul respirations
• Sugar >600, bicarb 310
• Fluids and insulin

Answer 2

Hyperglycemic hyperosmolar state (coma)

Question 3

• Formed by glucose aerobically metabolized
• Increased production of lactic acid (tissue hypoxia), deficient removal (hepatic failure) or both (circulatory collapse)
• Tachypnea, variable presentation
• Acidosis (pH15, lactate >5)
• Bicarb & tx underlying cause

Answer 3

Lactic Acidosis

Question 4

• Early morning spike in BS
• Possibly release of GH, cortisol, glucagon or epi which cause liver release of glucose
• Reduce carbo intake at bedtime; insulin pump

Answer 4

Dawn phenomenon

Question 5

• Rebound BS in réponse to hypoglycemia
• Nocturnal hypoglycemia leads to dawn effect
• Eliminate dose of insulin at dinnertime and give lower dose at bedtime

Answer 5

Somogyi effect

Question 6

• Too much insulin, given too quickly drops glucose too fast

- Drowsiness, inabiltiy to arouse

Answer 6

Insulin rx/hypoglycemia/reactive hypoglycemia