Diabetes, SIADH, DI

Question 1

What is Diabetes Insipidus (DI)?

Answer 1

-Low ADH levels (Causes you to PEE), High serum Osmolality
-Polyuria of diluted urine
-Polydipsia
-Dehydration do to Peeing a lot
-Fluid vol. deficit
-Low Specific gravity when high urine output
Fluid Deficit & High Sodium do to high concentration
-Blood=High concentration (Hct high)
-Urine= diluted (BUN/Gravity low)

Question 2

What is (SIADH) Syndrome of inappropriate antidiuretic hormone secretion ?

Answer 2

-High ADH levels (Causes you to hold Pee pee)
-More water than sodium is retained by kidneys
-Oliguria (low pee)
-Not thirsty
-Fluid volume excess
-High Specific gravity when urine output low
Fluid Overload & low sodium do to high dilution

Question 3

DM1 insulin status & S/S

Answer 3

Insulin dependent & Ketosis prone
S/s: polyuria, Polydipsia, Polyphagia

Question 4

DM1 treatment & Education

Answer 4

—>DIE
Diet
Insulin (most important)
Exercise
Ed: Insulin compliance

Question 5

DM2 insulin status & S/S

Answer 5

Non-inulin dependent & non ketosis prone
-S/S: Polyuria, Polydipsia, Polyphagia

Question 6

DM2 Tx & Pt. education

Answer 6

—-> DOA
Diet (Most important)
Oral hypoglycemia
Activity
-Ed: Daily calorie restriction, 6 small meals/day

Question 7

INSULIN
Rapid Acting
-Humalog/Lispro

Answer 7

Onset: 15-30 min
Peak: 0.5-2.5hr
Duration: 3-6hr
Give WITH food

Question 8

INSULIN
Short Acting
-Regular

Answer 8

Onset: 0.5-1hr
Peak: 1-5hr
Duration: 6-10hr
Give BEFORE Meal Clear solution
-Can be given drip IV

Question 9

INSULIN
Intermediate
-NPH

Answer 9

Onset: 1-2hr (6hr)
Peak:6-14hr
Duration: 16-24hr
Give AFTER Meal cloudy suspension
-NEVER give IV

Question 10

INSULIN
Long Acting
-Lantis/Glargine

Answer 10

Onset: slowly absorbed 70 min
Peak: none
Duration: 24 hr
Give at BEDTIME

Question 11

Pt. Education on Insulin
-Exercise…
-Sick days…

Answer 11

Exercise:
-Increased exercise= decreased need for insulin
-Low exercise=high need for insulin
Sick Days:
-Take insulin even if Not eating
-Sip on H2o prevent dehydration

Question 12

When does a insulin vial expire once opened?

Answer 12

expires 30 days once opened
-Date open date & date expires

Question 13

Do you refrigerate insulin vials?

Answer 13

Yes, Unopened vials must be refrigerated

Question 14

What causes HYPOFLYCEMIA?

Answer 14

1. not eating enough
2. Too much exercise
3. Too much insulin
   -leads to cerebral impairment & vascular collapse via low glucose/energy
   -can lead to permanent Brain Damage

Question 15

S/S of Hypoglycemia

Answer 15

Vitals: High HR & Low BP
-Appearance: Pale, Clammy skin
-Behavior: Slurred speech, staggered gait, delayed reaction time, uncontrolled emotions
(Similar to a drunk person/shock person behaves Drunk+Shock)

Question 16

TX for Hypoglycemia

Answer 16

1. Give CHO (Sugar)
   –Food w/ Protein + Sugar (juice & crackers, milk)
2. If Unconscious NPO
   –Give glucagon IM or Dextrose IV (D10 or D50)

Question 17

What causes DKA

Answer 17

-Extreme Hypoglycemia
1. Acute upper respiratory viral infection in last 1-2 weeks
2. too much food
3. Not enough exercise
4. not enough insulin

Question 18

S/S of DKA

Answer 18

Dehydration: Dry skin, hot/flashes, WEAK/Thready Pulse, warm
Ketones: HyperKalemia, Kussmaul Respirations, High K+
Acidosis: Fruity breath, anorexia w/ nausea

Question 19

TX. for DKA

Answer 19

1. IV insulin drip (REGULAR)
2. IV Fluids @ 200ml/hr (high rate)

Question 20

What is Hyperosmolar hyperglycemia non-ketoacidosis (HHNK) & Tx.

Answer 20

Hyperglycemia in DM2
Severe Dehydration
S/S similar to dehydration
Tx. Rehydrate glucose normal after

Question 21

Long Term complications of DM

Answer 21

1. Poor tissue perfusion
2. Peripheral Neuropathy
   -Due to high sugar in blood for long time blood becomes thicker

Question 22

What is the best lab test for pt. glucose control (long term?)

Answer 22

Hemoglobin A1C/HbA1C
higher then 7 out of control