DM complications: HHS, Hypoglycemia Flashcards
What is HHS
Hyperosmolar Hyperglycemic Syndrome
- life threatening syndrome that occurs with TYPE 2 DIABETES.
What are precipitating factors of HHS
- UTI’s, pneumonia, sepsis
- Acute Illness/trauma
- Newly diagnosed type 2 diabetes
- Only occurs with type 2 diabetes
- Impaired thirst sensation and/or inability to replace fluids
- More like threatening then DKA
With HHS there is enough circulating _____ to prevent _________
insulin to prevent ketoacidosis.
HHS has fewer symptoms and leads to higher bg levels greater than
600mg/dl
HHS has more severe neurological manifestations because of
increased serum osmolarity
Therapies for HHS
- IV insulin and naCl infusions
- fluid replacement (4 liters NS ASAP)
- monitor serum potassium and replace as needed
- hourly blood sugar
Nursing management for HHS. Monitor this stuff
IV fluids
insulin therapy
electrolytes
Nursing management of HHS. Assess these things
LOC— biggest deal with these patients!!!
Renal status
cardiopulmonary status
**WHEN old glucose decreases to below 250 switch to D5W.
Hypoglycemia is
- to much insulin in proportion to glucose in the blood
- blood glucose level less than 70 mg/dl
- neuroendocrine hormone released
- autonomic nervous system activated
common manifestations of hypoglycemia are……..
THESE ARE GREAT SATA QUESTIONS
- shakiness
- palpitations
- nervousness
- diaphoresis
- anxiety/nervousness
- hunger (response to low sugar)
- pallor
- altered mental functioning (difficulty speaking, visual disturbances, stupor, confusion, coma)
**the s/s can mimic alcohol intoxication
untreated hypoglycemia can progress to…..
loss of consciousness
seizures
coma
death
whats hypoglycemia unawareness
- no warning signs/symptoms until the glucose level critically low
- its related to autonomic neuropathy and lack of counterregulartory hormones.
causes of hypoglycemia
- too much insulin or oral hypoglycemic agents
- to little food
- delaying time of eating
- too much exercise
- high glucose level falls to rapidly can cause symptoms
What do you do for your hypoglycemic patient based on glucose level
- if less than 70 mg/dl begin treatment
- if more than 70 mg/dl investigate for cause of s/s
- if monitoring equipment not available, treatment should be initiated.
Whats the rule of 15
- Consume 15 g of a simple carbohydrate (fruit juice or regular soft drink, 4-6 oz)
- Recheck glucose level in 15 minutes (repeat if bg is still less that 70 mg/dl)
- Avoid foods with fat (they decrease absorption of sugar )
- Avoid overtreatment
- Give complex CHO after recovery (like peanut butter w/crackers)
