DM, DKA, HHNS Flashcards
Hormones made by the beta cells of the pancreas
insulin and amylin (incretin hormone)
glucagon is made by the _____ cells of the pancreas
alpha
Glucagon works opposite of _____ preventing hypoglycemia
insulin
Functions of amylin
slows gastric emptying, suppresses glucagon secretion, and increases satiety
The liver and muscles store glucose as
glycogen
_________ is main fuel for the body
glucose
Glucose mainly comes from food, but the _____ can produce glucose also
liver
If the liver does not have glycogen, the body will break down ___ and _____ for energy
fats; proteins
breakdown of fats
lipolysis
Protein breakdown
proteolysis
A1c > ___ is diagnosed diabetes
6.5%
Fasting plasma glucose > ___ mg/dL is diagnosed diabetes
126
Random plasma glucose > ___ mg/dL is diagnosed diabetes
200
Examples of medications that can cause hyperglycemia
steroids
beta blockers may mask the signs and symptoms of
hypoglycemia
micro/macrovascular changes and complications can occur ___-___ years before diagnosis of diabetes
5-10
hypoglycemia is classified as blood sugar < ___ mg/dL
70
Characteristics of hypoglycemia
acute complication, sudden onset, requires immediate treatment, can cause cognitive impairment
Hypoglycemia precipitating factors
skipping meals, exercising more than normal, taking too much insulin or oral medications
S/S of hypoglycemia
shakiness, dizziness, diaphoresis, tachycardia, blurred vision, changes in mental status
Hypoglycemia nursing care
immediate treatment, increase glucose level, monitor CNS changes
Characteristics of DKA
sudden onset, life-threatening, most common with Type I diabetics but can occur in Type II diabetics although rare
DKA precipitating factors
infection (elevates BS), vomiting, inadequate insulin, undiagnosed diabetes, medications (steroids), not eating
DKA key players
glucose, insulin, liver and glucagon, ketones, kidneys
DKA manifestations
hyperglycemia, metabolic acidosis, production of ketones, Kussmaul respirations, dehydration (electrolyte imbalances such as hyponatremia/kalemia)
During DKA, respirations increase so the lungs blow off ___ from the body to raise pH
CO2
metabolic acidosis
low pH, low HCO3, normal or no change in PCO2
DKA manifestations
electrolyte imbalances (low K+, Na, bicarb), polyuria, polydipsia, fatigue, weight loss
glucose associated with DKA
> 300 mg/dL
Serum and urine ketones will be _________ in DKA
positive
Serum pH related to DKA
< 7.35 (acidosis)
Serum bicarb related to DKA
< 15 mEq/L
BUN related to DKA
> 30 mg/dL (elevated)
creatinine related to DKA
> 1.5 mg/dL (elevated)
Anion gap related to DKA
> 17
normal anion gap
5-17
Test that measures the acid-base balance and electrolyte balance of blood
anion gap
Treatment of DKA
immediate treatment: 1) hydrate with IV fluids (NS, D5W to balance blood sugars/prevent hypoglycemia), 2) lower blood gluocse with REGULAR insulin drip, monitor potassium level, correct acid-base imbalance
Characteristics of Hyperglycemia Hyperosmolar Non-ketonic State (HHNS)
gradual onset, more common in type II diabetics
HHNS precipitating factors
infection, stressors, poor fluid intake (dehydration)
HHNS key players
glucose, insulin, kidneys
Why do type II diabetics not typically enter ketosis?
because unlike type I diabetics, there is just enough insulin to get glucose into cells
HHNS manifestations
altered CNS function, seizures, electrolyte loss, dehydration, severe hyperglycemia
HHNS typically occurs in
older clients with type II diabetes
Glucose related to HHNS
> 600 mg/dL
Osmolarity related to HHNS
> 320 mOsm/kg
Serum ketones will be _________ in HHNS
negative
Serum pH related to HHNS
> 7.3
Serum bicarb related to HHNS
> 20 mEq/L
BUN and creatinine will be ________ with HHNS
elevated
HHNS treatment
1) hydrate (fluid therapy to increase blood volume), 2) decrease blood glucose, correct electrolyte imbalance
Patient education of prevention of DKA
monitor glucose when ill, watch for and report any illness lasting more than 1-2 days, check blood glucose levels every 4-6 hrs if anorexia, N/V is experiences, check urine ketones when BG is greater than 300 mg/dL
normal A1c
< 5.6%
Prediabetes A1c
5.7 - 6.4%
target A1c after diagnosis of diabetes
< 7%
Treatment of hypoglycemia
immediate treatment; 15 g of simple carb (oral if conscious and able to swallow), if unconscious: IV glucose (D50) or glucagon IM, recheck BG after 20 min, eat a snack/small meal after BG is > 70 mg/dL
Patient education of prevention of hypoglycemia
do not skip meals, no exercising on empty stomach, check BG before exercise (if < 100, eat a snack before exercise and take a snack with you)
Examples of simple carbs for the treatment of hypoglycemia
juice, candy (CHEW, do not suck), regular soda, spoonful of sugar if nothing else
DKA protocol
IV fluids, IV insulin, vital signs, correction of acidosis, administer potassium, administer bicarbonate, administer D5 or D10 per protocol, DKA resolved when labs within normal range according to facility
DKA treament
follow DKA protocol, fluids, IV insulin (regular), decrease blood glucose GRADUALLY (prevents further electrolyte imbalances and hypoglycemia)
HHNS treatment
IV fluids, sliding scale insulin protocol, correct electrolyte imbalance
Diabetes long-term care
4 M’s: monitor, motion (exercise), medication, meal planning
Older adult diabetes considerations
increased prevalence and mortality, glycemic control challenging, increased hypoglycemic unawareness, functional limitations, renal insufficiency, diet and exercise (main treatment), patient teaching must be adapted to needs, HHS more prevalent in older adults
why are older adults more likely to have hypoglycemia?
older adults have a decreased metabolism causing medications to stay in system longer
Pediatric diabetes considerations
medical management is similar to adults, requires parent participation, promotion on health growth and development, DKA more prevalent in younger clients
