Diabetes DKA HHA

Question 1

What are the 3 main causes of DKA

Answer 1

1. Decreased or missed dose of insulin
2. Illness or infection
3. Undiagnosed or untreated diabetes ( DKA may be the initial manifestation of type 1 diabetes)

Question 2

What is true of a sick pt and diabetes

Answer 2

Infections and illness can increase blood glucose levels a person does not need to decrease the dosage of insulin to compensate for decreased food intake. In fact you may have to give insulin more frequently or eat small snacks in between to compensate for the higher BS levels while Ill.

Question 3

What are clinical manifestations of DKA

Answer 3

The hyperglycemia of DKA leads to polyuria, polydipsia, and marked fatigue (because when the body breaks down fat for energy is using the anaerobic process of making energy for the cells which burns and tires more easily because their is no oxygen.)

Question 4

What does the ketosis and acidosis of DKA lead to

Answer 4

It leads to GI symptoms such as Anorexia, nausea, vomiting, abdominal pain, fruity breath from the ketones. Kaussmal respirations represent the body’s attempt to decrease acidosis, counteracting the effect of the ketone buildup. Mental status changes vary widely

Question 5

What are assessment and diagnostic findings of a person with DKA

Answer 5

Blood glucose levels vary between 300-800.
Evidence of ketoacidosis is reflected in low serum bicarbonate (0-15)
And low pH (6.8-7.3)
A low partial pressure of carbon dioxide ( 10-30) reflects respiratory compensation ( kussmaul respirations for metabolic acidosis)
Accumulation of ketone bodies which represents the acidosis is reflected in blood and urine ketone measurements.Increased CR, BUN and HCT may be seen from dehydration for the kidney trying to rid the body of excessive glucose.

Question 6

In a person with DKA, once they have been rehydrated and they express a continued elevation of creatine and BUN levels, what does this mean

Answer 6

It suggests underlying renal insufficiency

Question 7

In addition to treating hyperglycemia in DKA, what must also be treated

Answer 7

Dehydration, electrolyte loss, and acidosis must be corrected before correcting the hyperglycemia with insulin.

Question 8

In a diabetic dehydrated person rehydration does what

Answer 8

Rehydration is important for maintaining tissue perfusion.
In addition, fluid replacement enhances the excretion of excessive glucose by the kidneys. The pt may need as much as 6-10 L of IV fluid to,replace fluid losses by polyuria, hyperventilation, diarrhea and vomiting.

Question 9

What fluids should be given during dehydration

Answer 9

Initially 0.9 % sodium chloride ( normal saline) is administered at a rapid rate, usually 0.5-1L per hour for 2-3 hours.
ThE half strength 0.45% normal saline also known as hypotonic saline solution may be used for patient with hypertension or hypernatremia, and those at risk for HF.
After the first few hours 0.45% NaCl is the solution of choice.
When the blood glucose reaches 300 or less, the IV solution may be changed to dextrose 5% in water (D5W) to prevent a decline in blood sugar levels

Question 10

What’s the major electrolyte concern during DKA

Answer 10

K+ because as the body rehydrates itself, sodium is gained and potassium is lost, leading to potential dysrhythmias

Question 11

How is the acidosis reversed

Answer 11

Fat breaks down into ketones in the absence of insulin which lets glucose into the cells for energy.. If you give the person insulin glucose is let into the cells and the breakdown of fat is no longer needed. Reversing the acidosis.

Question 12

What is HHS

Answer 12

Hyperglycemic hyperosmolar syndrome….
Is a metabolic disorder of type 2 diabetes resulting from insulin deficiency initiated by a illness that raises the demand for insulin, resulting in hyperglycemia without the ketones because there is just enough insulin being produced to prevent the body from breaking down fat for energy but not enough to prevent hyperglycemia.

Question 13

What are symptoms of HHS

Answer 13

The pt. Will not experience ketosis related GI SYMPTOMS. They will experience polyuria and polydipsia until neurological changes, an underlying illness, or the a family member promos them to seek help.
Hypotension, profound dehydration ( dry mucous membranes, poor skin turgor) and tachycardia

Question 14

What is administered to patients with HHS after there BS has dropped to 250-300

Answer 14

After insulin is administered at low rates to treat hyperglycemia, and replacement fluids with dextrose is administered after BS levels drop to 250-300

Question 15

What are the 3 complications of diabetic ppl

Answer 15

Macro vascular disease, ( heart) more common in type 1 diabetes
micro vascular disease, (Kidneys, retina) more common in type 2 diabetes
neuropathy

Question 16

What exactly is macro vascular disease

Answer 16

It results from over time blood vessel walls thickening and becoming occluded by plaque. Eventually blood flow is blocked. These changes occur at youger ages with ppl with diabetes due to the excess sugar circulating in there blood. CAD, cerebrovascular disease and peripheral vascular disease are the 3 main types of macro vascular diseases that occur in patients with diabetes.

Question 17

What is diabetic acidosis

Answer 17

It is caused by a absence or markedly inadequate amount of insulin.
With the absence of insulin, unable to let glucose in the cells for energy, the body thinks it is starving, thus the liver begin gluconeogenesis, releasing more glucose. Leading to hyperglycemia. In an attempt to rid the body of the extra glucose, the kidneys excrete glucose and Na and k+ out of the body (polyuria) which leads to dehydration
As glucose is still unable to get into the cells because of the lack of insulin; the body is forced to break down fat for energy. This process releases ketones in the body fro the liver which are acids that leads to metabolic acidosis.

Question 18

What are signs and symptoms of peripheral vascular disease

Answer 18

Diminished peripheral pulse, intermittent claudication ( pain in the buttock, thigh or calf during walking) this is due to the atherosclerotic changes in the large blood vessels of the lower extremities
The severe form of arterial occlusive disease in the lower extremities can lead to gangrene and amputations.neuropathy and impairments in wound healing also play a role in diabetic foot disease.

Question 19

What are other potential factors that can play a role in diabetes related atherosclerosis

Answer 19

Platelet and clotting factor abnormalities
Decreased flexibility of RBC
decreased oxygen release
Changes in the arterial walls related to hyperglycemia and possibly hyperinsulinemia.

Question 20

What are micro vascular complications of diabetes

Answer 20

It is characterized by capillary basement membrane thickening. Two areas affected by the changes are the retina and the kidneys
Diabetic retinopathy is the leading caused of blindness among ppl 20-74 yrs of age occurring in type 1&2 diabetes.

Question 21

What are some changes that can occur to the eye in diabetic retinopathy

Answer 21

Cataracts- opacity of the lens of the eye they occur at an earlier age in diabetes.
Lens changes- the lens of the eye can swell when blood glucose levels are elevated, for some ppl visual changes may be the 1st symptom of diabetes.
Glaucoma- results from occlusion of the outflow channels by new blood vessels.

Question 22

Vitrectomy

Answer 22

Is a surgical procedure in which vitreous humor filled with blood or fibrous tissue is removed with a special drill like instrument and replaced with saline or another liquid.

Question 23

What is nephropathy

Answer 23

Nephropathy or kidney disease secondary to micro vascular changes in the kidney is a common complication of diabetes.

Question 24

How long does it take with ppl with diabetes to show signs of kidney disease.

Answer 24

10-15 yrs for type 1

10 yrs for type 2 because they go a longer time without being diagnosed

Question 25

Why do they kidneys fail in diabetic ppl

Answer 25

If blood glucose levels are elevated for a long period of time, the kidneys filtration system is stresses, allowing blood proteins leak in the urine. As a result the pressure in the blood vessels of the kidneys increases