Diabetes Flashcards
Diabetes Mellitus (DM)
error in glucose metabolism
type 1: lack of insulin
type 2: insulin resistance
-lose water
-lose weight
-HIGH urine output
-fluid volume deficit
Diabetes Insipidus (DI)
NOT DM ( no glucose issues just fluids)
Low ADH causes polyuria, polydipsia leading to DEHYDRATION
-lose water
-lose weight
-HIGH urine output
-fluid volume deficit
SIADH
(Syndrome of inappropriate ADH)
Opposite of DI
oliguria and not thirst
-retain water
-gain weight
-LOW urine output
-fluid volume excess/overload
-decrease serum specific gravity
-increase urine specific gravity
Type 1 DM characteristics
insulin dependent
juvenile onset
ketosis prone
Type 2 DM characteristics
non-insulin dependent
adult onset
non-ketosis prone
S/sx of DM (3 Ps)
Polyuria- pee a lot
Polydipsia- thirsty
Polyphagia - swallowing a alot b/c of increased appetite
DM Type 1 treatment
if you dont treat they will DIE
Diet -least important, carb calories
Insulin - most important
Exercise
DM type 2 Tx
They are DOA
Diet (most important)
-calorie restriction (best/priority tx)
-6 feedings a day
Oral hypoglycemic
Activity
Insulin Types
Acts to lower blood sugar
1. R-regular
2. N-NPH
3. Lispro (Humalog)
4. Glargine (Lantus)
R-Regular insulin
1-2-4
-clear = solution
-IV drip
-onset: 1 hr
-peak: 2 hrs
-duration: 4 hrs
Pattern 1-2-4
N-NPH
6-8-10-12
-intermediate insulin
-cloudy = suspension
-N =not so clear, not so fast, not in the bag (cant give IV drip)
-onset: 6 hrs
-peak: 8-10 hrs
-duration: 12 hrs
Pattern 6-8-10-12
Lispro (Humalog)
15- 30 -3
-rapid/fastest acting insulin
-Give it with their meal (interrupt eating)
-onset: 15 min
-peak: 30 min
-duration: 3 hrs
pattern 15- 30 -3
Glargine (Lantus)
12-24
Long- acting insulin
NO PEAK
duration: 12-24 hrs
given safely at bedtime, littlerisk for hypoglycemia
Insulin Packaging
ALWAYS CHECK EXP DATE
-once open the new exp date is 30 days away
-label open package with the date it was opened & day it expires
-unopened MUST be refrigerated
-opened then refrigeration is optional
Exercise & Insulin
exercise is like a shot of insulin
increased exercise - decrease insulin dosage
decreased exercise - increase the insulin dosage
Diabetes & Sickness
-glucose goes up even if theyre not eating
-MUST USE INSULIN regardless of meals
-stay active
-major problem is hyperglycemia & dehydration
Acute Comlications
Low blood glucose (hypoglycemia/hypoglycemic shock/insulin shock or reaction)
Causes:
-not enough food
-too much insulin (#1 cause- lead to brain damage)
-too much exercise
Hypoglycemic Shock s/sx
Drunk in Shock
Drunk pt in Shock
Drunk:
-staggering
-slurred speech
-labile (emotional)
-slow reaction time
-decreased social inhibition
Shock:
-tachycardia/pnea
-low BP
-Cold, clammy, mottled skin
Hypoglycemic Shock Tx
-give sugars or rapid metabolizing carbs
-sugar + starch/protain
-Glucagon IM
-Dextrose IV (d10 d50)
DKA
ONLY IN TYPE 1
Causes:
#1 cause is acute viral upper respiratory infection within the last 2 weeks
too much food
not enough insulin
not enough exercise
DKA S/sx
DKA
dehydration
Ketones, Kussmauls, High K(potassium)
Acidosis (metabolic), acetone breath, anorexia due to nausea
-ketones in the blood =DKA
-ketones in urine not always DKA
DKA Tx
Insulin IV (regular)
IV fluid 200ml/hr fastest rate
HHNK/HHS/HHNS
ONLY IN TYPE 2
very high blood sugar
Think SEVERE DEHYDRATION
-dry skin, flushed, decreased turgor, increased HR
tx: rehydration
Long term complications: poor perfusion, peripheral neuropathy
DKA vs HHNK
DKA - dependent on insulin
-higher priority
-less death
HHNK needs re -e hydrate
-lower priority
-more deaths (pts come to ED too late)
Long term complications
Either related to:
-Poor tissue perfusion (renal failure)
-Peripheral neuropathy (urinary incontinence)
Hb A1c
best indicator of long term blood glucose level
under 6 = normal
7 = borderline (needs evaluation)
over 8 = out of control