diabetes complications Flashcards
ACUTE COMPLICATION OF DM
HYPOGLYCEMIA
DIABETIC KETOACIDOIS (DKA)
HYPERGLYCEMIC HYPEROSMOLAR SYNDROME (HHS PREVIOUSLY KNOWN AS HHNK)
IMPORTANCE OF GLUCOSE
Glucose is the fuel that provides energy for cells
Insulin dependent cells for glucose transport
Adipose tissue
Skeletal muscles
Without insulin → Cellular starvation
HYPOGLYCEMIA: BG #
BG <70
Treatment of Hypoglycemia - rule of 15
Rule of 15”
At first sign, 15g of PO simple carb
15g simple sugar (5-6 hard candies, 3 glucose tabs), 4-6 oz apple or orange juice or a regular soda
If hypoglycemia persists after 10-15 minutes, repeat x 2-3. Call PCP if no improvement
Treatment of Hypoglycemia - if inpatient -
Inpatient:
12.5 to 25gm (25-50mL) Dextrose 50% IVP if NPO
Hypoglycemic Unawareness**- and who gets it?
body doesn’t signal when hypoglycemia is occuring
When a person lacks the autonomic nervous system triggers to hypoglycemia
Usually found in people with long-standing DM I, frequent episodes of hypoglycemia and older people**
Diabetic Ketoacidosis (DKA) - is it fast or slow?
Usually occurs with DM1 but can occur with DM2 in severe illness or stress when the pancreas cannot meet the extra insulin demand
Occurs abruptly
DKA - patho - 1
(dik is 1 fat ketone)
Profound insulin deficiency
Metabolism of fat storage resulting in ketone byproducts → ketoacidosis → metabolic acidosis
dka - s/sx - the Ps
3Ps: Polyuria, Polydipsia, Polyphagia
DKA: LAB FINDINGS - BG (DKA in the year 300)
BG > 250-300mg/dl
DKA: TREATMENT = CORRECT DEHYDRATION - and what number to give dextrose?
THREE TARGETS:
CORRECT DEHYDRATION:
Fluid replacement
Start with 1/2NS or NS to achieve staple BP. Then IVF with dextrose when BG approaches 250 mg/dl to prevent hypoglycemia
HYPEROSMOLAR HYPERGLYCEMIC SYNDROME (HHS) - what is BG?
Severe hyperglycemia > 600 mg/dl
HHS: causes
Etiology:
HHS less common than DKA
Infection: UTI, PNA, sepsis, pancreatitis
Elderly > 60 yrs old
Neglected DM
Undiagnosed DM
HHS often related to impaired thirst sensation and/or functional inability to replace fluids
Lab values:
BG > 600mg/dL
HHS : TREATMENT- monitor for what with IV fluids?
Large volumes of fluid replacement with NS or ½ NS is priority
Insulin infusion
Monitor for signs of fluid overload
Pulmonary edema (SOB, ↑O2 requirement, DOE, orthopnea, anxiety, pink frothy sputum)
Monitor cardiac and renal function
Electrolyte replacement
Correct precipitating factor
Complications of chronic uncontrolled diabetes
ANGIOPATHIES
MACROVASCULAR COMPLICATION:
Large and medium sized blood vessels
Increase risk for: CAD, CVA, PVD, HTN
MICROVASCULAR COMPLICATION:
From long standing diabetes over 10-20 years
Neuropathy
Retinopathy
Nephropathy
Skin changes
NEUROPATHY
SENSORY NEUROPATHY: OCCURS IN 60-70% OF PATIENTS
Distal symmetric polyneuropathy affecting both hands and feet
PVD and PAD
Abnormal sensation: paresthesia, tingling, burning, itching
AUTONOMIC NEUROPATHY: AFFECTS ALL BODY SYSTEMS
Hypoglycemic awareness
Urinary retention and bowel incontinence d/t ↓ sensation of bladder and colon walls
Gastroparesis: anorexia, n/v, Gerd, persistent feeling of fullness
Cardiovascular: postural hypotension, silent/painless MI
Sexual dysfunction
NEPHROPATHY
Glomerular basement membrane thickening
Damage to small blood vessels of the glomeruli: glomerular sclerosis
Leading cause of ESRD (end stage renal disease) in U.S.; Occurs in 20-40% of diabetics
RETINOPATHY
Most common cause of new adult blindness
Microaneurysm of the small blood vessels in the retina
Mild to total vision loss depending on the area of aneurysm
Neovascularization occurs but new vessels are very fragile and prone to hemorrhage
INTEGUMENTARY = Acanthosis nigricans
Acanthosis nigricans – velvety light brown or black skin thickening
Manifestation of insulin resistance
Appears on neck, axillae, flexures
INFECTIONS
More susceptible to infections due to impaired mobilization of WBC and phagocytes
High levels of sugar brew more bacteria
Candida Albicans
Slow wound healing
Bladder infections d/t glycosuria and neurogenic bladder
Angiopathy prevents or delays immune response
Education:
Hand hygiene
Personal hygiene
Annual vaccine
Pneumococcal vaccine