DM ppt 2 Flashcards
DM gerontologic considerations
oral agents take longer to be excreted by kidneys poor eyesight may lead to insulin errors skip meals (anorexia or financial reasons) live alone and do not recognize s/s hypoglycemia
hypoglycemia
low glucose level (<50-60 mg/dL)
hypoglycemia causes
too much insulin
oral hypoglycemic agents
excessive physical activity
insufficient food intake
hypoglycemia s/s
sweating tremors, seizures tachycardia, palpitations headache, confusion, disorientation, LOC, slurred speech, drowsiness, memory/concentration issues hunger
hypoglycemia mgmt
give 15g concentrated carb
(3 or 4 glucose tablets or 4-6 oz juice/soda)
retest in 15 min
repeat if <70 mg/dL or if symptoms persist
snack with protein/carb
hypoglycemia emergency measures
if pt cannot swallow: subcutaneous or IM glucagon (1mg), 25-50mL 50% dextrose IV
glucagon
packaged as powder
mix with diluent
takes effect 8-10 min
nausea may occur; turn pt on side
hypoglycemia prevention
do not skip or delay meals eat a snack ever 4-5 hrs increase food intake before exercise if <100 mg/dL carry fast acting sugar at all times wear a medical alert bracelet
DKA
triad: hyperglycemia, dehydration (loss of electrolytes), acidosis
may lose up to 6.5 L of water and 400-500 mEq of sodium, potassium, and chloride
DKA causes
decreased/missed doses of insulin
illness/infection
undiagnosed/unmanaged DM
“sick day rules”
never eliminate doses of insulin with n/v
drink fluids hourly to prevent dehydration
check blood glucose and urine ketones every 3-4 hrs
DKA s/s
polyuria, polydipsia, fatigue blurred vision, weakness, headache orthostatic hypotension, weak pulse, tachycardia n/v, abdominal pain, anorexia acetone breath (elevated ketones) hyperventilation
DKA assessment
blood glucose 300-1000 mg/dL low serum bicarb, low pH ketones in blood and urine electrolyte imbalance 2/2 dehydration BUN, Cr, Hct elevated
DKA treatment
rehydrate with IV fluids
0.9% at rapid rate
0.45% solution may be used for pts with HTN, hypernatremia, r/o HF
when glucose is <300, IV changed to dextrose 5% in water
check for s/s fluid overload
DKA restoring electrolytes
potassium of most concern (possible dysrhythmias)
potassium must be infused even if serum K is normal
frequent ECGs and blood potassium levels first 8 hrs
DKA reversing acidosis
insulin reverses DKA, ends ketone production/acid buildup
slow IV infusion (5 units/hr) until subcutaneous insulin can be resumed (12-24 hrs)
hyperglycemic hyperosmolar syndrome (HHS)
caused by a lack of sufficient insulin ketosis is minimal or absent! persistent hyperglycemia causes osmotic diuresis (loss of water and electrolytes) mostly in older adults (50-70) high mortality rate
HHS s/s
hypotension dehydration tachycardia decreased/altered consciousness seizures hemiparesis
HHS causes
caused by a lack of sufficient insulin 2/2:
infection
precipitating event
medications that exacerbate hyperglycemia
HHS assessment
blood glucose electrolytes, BUN, CBC ABG serum osmolality dehydration
HHS treatment
fluid replacement correct electrolyte imbalances insulin administration give K when urine output is adequate monitor for HF, FVE, arrhythmias may take 3-5 days before neurologic symptoms clear
DM long term vascular complications
accelerated atherosclerosis CAD cerebrovascular disease (stroke) PVD diabetic retinopathy nephropathy
DM foot/leg complications
loss of pressure and pain sensations
increased dryness, fissuring of skin
muscular atrophy (changes shape of foot)
poor circulation of lower extremities leads to poor wound healing and development of gangrene
DM foot care
daily visual inspection wash and dry feet daily apply lotion to tops and bottoms but not between toes podiatrist to trim nails wear shoes and socks at all times elevate feet when sitting wiggle toes, move ankles 2-3x daily
