Exam 4 - DM Flashcards
hypoglycemia is consider < ___
70
severe/critical hypoglycemia is considered < ___
40
hypoglycemia s/sx
confusion
irritability
diaphoresis
tremors
hunger
weakness
visual disturbances
tachycardia
eventual seizures
hypoglycemia can mimic ___ ___
alcohol intoxication
rule of 15 is applied when BGL is < ___
70
Rule of 15
15-20 G of simple carb (4-6oz juice, soda, low fat milk; glucose gel, tablets)
recheck in 15 minutes; if still < 70 give another 15G of simple carb; reassess in 15 minutes
when to call PCP or 911 during Rule of 15
no improvement after 2-3 doses of carb
after BGL is above 70, give the pt a meal that contains ___ and recheck glucose in ___ minutes
protein (peanut butter, bread, cheese/crackers)
45 minutes
which oral DM med class can cause hypoglycemia
sulfonylureas
unconscious pt with hypoglycemia should be treated with
glucagon 1mg IM or SQ
Dextrose 20-50 mL IVP
glucagon has a quicker response when administered in which muscle
deltoid
pt positioning if unconscious during hypoglycemia
on their side to prevent possible aspiration
gerontologic considerations regarding DM
decrease kidney function (higher risk for hypoglycemia)
inability to prepare foods
poor access to foods
visually impaired
higher glycemic target to prevent hypoglycemia
educate: s/sx; rule of 15
DKA is caused by
profound deficiency of insulin
DKA is characterized by
hyperglycemia
ketosis (acidosis)
dehydration (osmotic diuresis)
daily and hourly UOP for osmotic diuresis
6 L/day
250 mL/hour
DKA is more common in which type of diabetic
DM 1
during DKA fat metabolism causes ___ leading to acidic blood; the breakdown of ___ causes excess ____.
ketones
muscle/protein/amino acids; glucose
DKA acid base imbalance
metabolic acidosis
low pH; low bicarb
daily and hourly UOP for polyuria
2-3 L/daily
80 mL/hour
glucose levels rise causes further ___ ___ which can lead to ___
osmotic diuresis; shock
DKA precipitating factor
illness, infection
inadequate insulin dosage
undx DM 1
poor self management/noncompliance
neglect
s/sx of DKA
dehydration
lethargy to coma
weakness
abdominal pain, N/V
Kussmaul (rapid, shallow)
acetone breath
serum glucose >300-1000
+ ketones blood, urine
increase Crt, Hct, BUN
is the severity of DKA r/t BGL
No
what electrolyte level must you know before administering insulin
K+
insulin can cause hypokalemia
DKA management
ensure airway
fluid resuscitation
K+ replacement
regular insulin drip
fluid resuscitation for DKA
1L NS/hourly
cardiac hx or elderly: 1/2 NS 200-500 bolus
regular insulin drip rate
0.1 unit/kg/hour
IV tubing regarding insulin administration
discard the first 50 mL
once BGL reaches 300, what is done?
DC insulin
administered D5W to prevent hypoglycemia
insulin to NS ratio
1:1
100 units in 100 mL
50 units in 50 mL
Hyperosmolar hyperglycemic syndrome (HHS) is d/t ___ ___
insulin resistance
HHS occurs commonly in which diabetics
DM 2
older adults (50-70s)
precipitating factors of HHS
infection: UTI, PNA, sepsis
acute illness
newly Dx DM2
impaired thirst sensation (dementia, PO intolerance)
does HHS have a high mortality rate?
Yes
BGL r/t HHS
600-1200
HHS s/sx
elevated BGL
ketones absent, minimal in blood and urine
dehydration
hypotension
tachycardia
neurological manifestions
–altered LOC, hallucinations, mimic a stroke, aphasia, mimic stroke s/sx
HHS treatment is similar to that of ___
DKA
how long will it take for HHS neuro changes to be corrected
several days
osmolality > ___ is risk for coma
340
3 possible causes of DM complications
nerve damage
decreased elasticity in molecules
decreased oxygenation
chronic vessel disease d/t hyperglycemia
angiopathy
leading cause of DM death is r/t
CVD, stroke
2 categories of DM complications
microvascular
macrovascular
macrovascular complications
MI
CAD
CVA
men 2x likely for MI; women are 3x more likely
microvascular complications
damage to small vessels
retinopathy
nephropathy
leading cause of blindness for ages 20-74
retinopathy
non-proliferative micro/retinopathy
partial occlusion
micro aneurysms
weak walls (retinal damage, hemorrhage)
blurred vision, floaters
proliferative micro/retinopathy
most severe
retina, vitreous humor
neovascularization
macular edema, hemorrhage
results in blindness
what must be performed annually on DM pts
dilated eye exam by an opthalmologist
damage to the small blood vessels that supply the glomeruli of the kidneys
nephropathy
leading cause of ESRD in the US
3 races with highest risk for dialysis
African Americans
Asian Americans
Hispanic Latios
nephropathy labs
microalbumin annually
serum Crt
24 hour urine
nephropathy meds
agressive BP management
ACE, ARB (renal protective)
most common type of neuropathy
peripheral
loss of sensation in lower extremities
increase risk for limb amputation
peripheral neuropathy sensation
burning, cramping, crushing, tearing
usually worse at night
peripheral neuropathy meds
antidepressants
anticonvulsants
type of neuropathy that affects nearly all body systems and leads to hypoglycemic unawareness, bowel incontinence, diarrhea, and urinary retention
autonomic
GI s/sx of autonomic neuropathy
gastroparesis (delayed gastric emptying)
—this can lead to hypoglycemia d/t delayed food absorption
anorexia
N/V
GERD
persistent feeling of fullness
autonomic neuropathy education
small frequent meals
increased hydration
exercise
enema PRN
bulk forming laxative
autonomic neuropathy meds
metoclopramide
reglan
given to stimulate peristalsis
Cardio s/sx of autonomic neuropathy
postural hypotension
resting tachycardia
painless MI
GU s/sx of autonomic neuropathy
neurogenic bladder (no urge to void)
schedule toileting, bladder training recommended
Reproductive s/s of autonomic neuropathy
ED (men, women)
nonspecific vaginitis
inability to orgasm
retrograde ejaculation: semen back flows into the bladder; will urinate out
most common cause of hospitalization in diabetics
foot, lower extremities ulceration
DM foot care
select proper footwear
avoid injuries to feet
practice diligent skin care
inspect daily
foot protection
keep feet soft; talons trimmed
–do not apply lotion between toes
psychosocial burdens of DM
depression
anxiety
hopelessness
communicate: teach, reteach
financial
eating disorders: bulimia, purge (esp younger type 1 pts)
open insulin vials are only good for how long
1 month
DM target BP
140/90
HTN BP meds for DM
ACE (1st line)
ARB
diet for BP/DM
DASH (dietary approach to stopping HTN)
low salt, low fat, high fiber
lipid targets for DM
cholesterol < 200
triglycerides < 150
diabetics should participate in physical activity at least ___ times a week
3
% of carb, protein, and fat intake for DM
carbs: 50-60%
protein: 20-30%
fats: 10-20%
beer, wine, and liquor consumption for DM
12 oz beer (low carb)
5 oz wine
1 oz liquor (recommend to avoid d/t high sugar)
1/daily for women; 2/daily for men
