Diabetes Flashcards

1
Q

Chronic Complications of DM

A
  • Caused by changes in blood vessels in tissue & organs
  • Vascular changes result from:
    > hyperglycemia thickens basement membranes & causes organ damage
    > hyperglycemia affects cell integrity
  • Changes in blood vessels lead to poor tissue perfusion & cell damange & death
  • 2 Types:
    > macrovascular
    > microvascular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Macrovascular

A
  • Cardiovascular disease
    > MI, HF
  • Cerebrovascular disease
    > 2-4x higher risk for stroke
  • Peripheral Vascular Disease (PVD)
    > PAD, leg ulcers
  • Risk factors of HTN, obesity, dyslipidemia, & sedentary lifestyle incr risk for these complications
  • Focus should be on dcring modifiable risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Microvascular

A
  • Retinopathy
  • Neuropathy
  • Nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Retinopathy

A

Caused by damage to retinal vessels causing leaking & retinal hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neuropathy

A
  • Progressive deterioration of nerves
  • Loss in sensation or muscle weakness
  • Caused by blood vessel changes tht cause nerve hypoxia
  • Can affect all areas of body (extrems, GI, cardiac, urinary)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Nephropathy

A
  • Change in kidney tht dcrs func & causes kidney failure
  • Chronic high BG causes damage to blood vessels in kidneys causing leaking & hypoxia
  • Kidneys allow filtration or larger particles which damage kidneys further
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lab Findings of DKA

serum glucose
osmolarity
serum ketones
serum pH

A
  • Serum Glucose: greater than 300
  • Osmolarity: variable
  • Serum Ketones: postive at 1:2 dilutions
  • Serum pH: less than 7.35
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lab Findings of DKA

serum hco3
serum Na
BUN
creatinine
urine ketones

A
  • Serum HCO3: less than 15
  • Serum Na: low, normal, or high
  • BUN: greater than 30; elevated bc of dehydration
  • Creatinine: greater than 1.5; elevated bc of dehydration
  • Urine Ketones: positive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lab Findings for HHS

serum glucose
osmolarity
serum ketones
serum pH

A
  • Serum Glucose: greater than 600
  • Osmolarity: greater than 320
  • Serum Ketones: negative
  • Serum pH: greater than 7.4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lab Findings HHS

serum hco3
serum na
BUN
creatinine
urine ketones

A
  • Serum HCO3: greater than 20
  • Serum Na: normal or low
  • BUN: elevated
  • Creatinine: elevated
  • Urine Ketones: negative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diabetic Ketoacidosis

A
  • Uncontrolled hyperglycemia, metabolic acidosis, incrd production of ketones
  • Sudden onset
  • Precipitating factors: infection, stress, inadequate insulin intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DKA Manifestations

A
  • Ketosis:
    > Kussumaul respirations
    > fruity breath
    > nausea
    > abdominal pain
  • Dehyration
  • Eectrolyte loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DKA Monitor

A
  • Airway
  • LOC/mental stat
  • Hydration
    > VS, I&Os
  • Electrolyes
    > assess for S/S hypokalemia: fatigue, malaise, confusion, muscle weakness, shallow resps, abdominal distention or paralytic ileus, hypotension, weak pulse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DKA Treatment

A
  • IV fluids
  • Regular insulin by continuous IV infusion
  • Replace potassium
    > ensure output is at least 30mL/hr
  • IV sodium bicarbonate
    > used only for severe acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hyperglycemic-Hyperosmolar State (HHS)

A
  • Hyperosmolar (incrd blood osmolarity) state caused by hyperglycemia
  • Gradual onset
  • Precipitating factors: dehydration, infection, poor fluid intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HHS Manifestations

A
  • Neurological symptoms:
    > seizures
    > myoclonic jerking
    > reversible paralysis
  • Severe dehydration & electrolyte loss
17
Q

HHS Monitor

A
  • Airway
  • LOC/mental stat
  • Hydration
    > VS, I&Os
  • Electrolytes
    > assess for S/S of hypokalemia: fatigue, malaise, confusion, muscle weakness, shallow resps, abdominal distention or paralytic ileus, hypotension, weak pulse
18
Q

HHS Treatment

A
  • IV fluids of NS if shock or severe hypotension, otherwise IV fluids of 1/2 NS
  • Assess for signs of cerebral edema (abrupt changes in mental stat, abn neurological signs, coma)
  • IV insulin is admind after fluids have been replaced
19
Q

Best Treatment for Hypoglycemia

A
  • Prevention
  • Avoid:
    > excess insulin
    > deficient intake or absorption of food
    > exercise
    > alcohol intake
20
Q

Hypoglycemia Treatment

A
  • Pts tht can orally intake:
    > 15-20 grams of oral glucose if below 70
    > 30 grams of oral glucose if below 50
    > repeat in 15mins if still below 70
  • Pts tht can’t orally intake:
    > glucagon SQ or IM
    > 50% dextrose IV
  • Frequent checl of BG following treatment
  • Follow protocols of hlth system/hosp