DM and Hyper/Hypoglycemia Flashcards
What are the four DM dx tests?
- RBG: Random Blood Glucose
- FPG: Fasting Plasma Glucose
- OGTT: Oral Glucose Tolerance
- A1C: Glycosylated Hemoglobin
Random Blood Glucose test (RBG)
- Food req: _____
- Tests for: _____
- Abnormal result: _____
- Food req: None
- Tests for: Glucose levels
- Abnormal result: >200 mg/dL
Random Blood Glucose test (RBG)
Other considerations
- Positive test is indicative of DM
- Confirmation will need to occur using either FPG, OGTT, or A1C tests
Fasting Plasma Glucose (FPG)
• Food req:
• Tests for:
• Abnormal Result:
- Food req: done post 8hr fast
- Tests for: body’s ability to regain glucose after digestion
- Abnormal Result: >126 mg/dL
Fasting Plasma Glucose (FPG)
Other level indications/notes
- Normal result = 70-105
- First line test method
- Dx confirmed when
- level is >126 on two occasions
- random test is >200
Oral Glucose Tolerance (OGTT)
• Food req:
• Tests for:
• Abnormal result:
- Food req: done post 8hr fast
- Tests for: body’s endurance to large glucose levels
- Abnormal result: >200 mg/dL
Oral Glucose Tolerance (OGTT)
Other considerations
- 140-200 mg/dL result means impaired glucose tolerance
- Test is post fast, then 75g of glucose, then level measured @2hr mark
- Other level info:
- Normal: ≤139
- Prediabetes: 140-199
- FX can be modified by pts taking glucocorticoids, diuretics or contraceptives
Glycosylated Hemoglobin (HbA1c or A1C)
• Food req: None
• Tests for: measures glycosylated hemoglobin (glucose present in RBCs)
• Abnormal Result: High levels (no number given)
- Food req: None
- Tests for: measures glycosylated hemoglobin (glucose present in RBCs)
- Abnormal Result: High levels (no number given)
Glycosylated Hemoglobin (HbA1c or A1C)
Other considerations
Measures glucose activity over time (90-120 days) as that is the lifespan of RBCs
Goal of DM Tx
Blood glucose reduced to 90-130
HbA1C of <7%
Insulin Onset
Time from admin of insulin to when it starts to act
Insulin Peak Time
Time insulin is at max activity strength
Insulin Duration
How long insulin activity lasts
What are the four insulin types?
- Rapid acting
- Regular or short acting
- Intermediate acting
- Long acting
Rapid acting
- Onset =
- Peak =
- Duration =
- Ex.
- Onset = 15mins
- Peak = 1hr
- Duration = 2-4hrs
- Ex.
- glulisine (Apidra)
- lispro (Humalog)
- aspart (NovoLog)
Regular or short acting
- Onset =
- Peak =
- Duration =
- Ex.
- Onset = 30mins
- Peak = 2-3hrs
- Duration = 3-6hrs
- Ex.
- Humulin R
- Novolin R
Intermediate acting
- Onset =
- Peak =
- Duration =
- Ex.
*
- Onset = 2-4hrs
- Peak = 3-12hrs
- Duration = 12-18hrs
- Ex.
- NPH (Humulin N, Novolin N)
Long acting
- Onset =
- Peak =
- Duration =
- Ex.
- Onset = Several hrs after admin
- Peak = Several hrs after admin
- Duration = 24hrs
- Ex.
- detemir (Levemir)
- glargine (Lantus)
What are the two vascular complications of hypergycemia?
Microvascular Disease & Macrovascular Disease
What are the 3 conditions that can arise from microvascular disease?
- Retinopathy
- Nephropathy
- Neuropathy
How does retinopathy manifest and how often should the diabetic be screened for it?
- blurred vision
- annually
What is nephropathy?
Kidney filtration malfunction
What are the s/s of Neuropathy?
- Orthostatic hypotension
- Activity intolerance
- Resting tachycardia
- Dysphagia
- N/V
- GI/Bladder elimination issues
- Erectile dysfunction and dry vag
- Poor skin healing
True or False
Neuropathy can be reversed.
False
It can be prevented or delayed, but not reversed
What is the blood glucose level of hypoglycemia?
<70 mg/DL
What does glucogon do?
- triggered by low levels of glucose, glucogon is triggered by the pancreas and signals the liver to breakdown glycogen and release glucose into the blood
- Glucogon -> Glycogen -> Glucose
What are the “3 p’s” of hypoglycemia?
- Polyuria
- Polyphagia
- Polydipsia
What is DKA?
- Diabetic Ketoacidosis
- A state of rapid, progressive escelation of hyperglycemia
What is the pathophysiology of DKA?
- Decreased insulin, leads to
- Breakdown of fat, leads to
- Ketogenesis, leads to
- Keytones in blood, leads to
- Ketoacidosis
How does acidosis + high glucose effect fluid/electrolyte balance?
- fluid and potassium shifts from cells to blood stream
- Polyuria drains extra fluid promoting dehydration/hypovolemia
- Potassium elimination is decreased in kidneys and builds up in blood = hyperkalemia
How is hyperkalemia treated in someone with DKA?
- Insulin first.
- Treat the cause of hyperglycemia and it should resolve itself
- Once glucose levels are within limits, potassium can be added via IV if necessary
In addition to the s/s of hyperglycemia what are other s/s of DKA?
- Dehydration
- Fruity breath
- Hypotensive w/ tachycardia
- Kussmaul resp
- Lethargy
- Confusion
- Abdominal pain
True or False
Fever is a s/s of DKA
- FALSE
- If fever is present, it is indicative of underlying infection
What is the key dx info for DKA?
- Keytones in urine
- Glucose > 300 mg/mL
- pH <7.3
- HCO3 <15
What are the goals of DKA tx?
- Correct fluid loss/hypotension: administer fluids
- Reverse hyperglycemia: insulin supplementation
- Prevent hypokalemia (as potassium shifts back into cells)
- Tx of any present/possible infection
What is the purpose of fluid administration for DKA?
- Correct hypovolemia and prevent vascular colapse
- Raise BP
- Ensure glomular profusion
How are fluids administered to treat DKA?
- Rapid IV infusion of normal saline @ 1 L/hr or faster to raise BP (typically a total of 3L over 5hr for adults)
- Once BP/urine flow is stablized, switch from normal saline to .45% saline
- Once glucose is <200 mg/dL, fluid should be switched to 5% dextrose in .45% saline to prevent hypoglycemia
What type of insulin is administered when treating hyperglycemia/DKA? When and why would that be switched?
- Regular
- It would be switched to long-acting 2-4hrs before discontinuation of regular IV drip to prevent rebound hyperglycemia when it regular IV is stopped
Why is the heart being monitored during DKA?
- due to the imbalances of potassium causing dysrhythmias
When can the addition of potassium be added to IV fluids when treating for hyperglycemia/DKA?
- when potassium levels fall below 5.3
When treating hyperglycemia/DKA, what is done when potassium levels fall past 3.3?
IV insulin will be stopped to bring up potassium levels
