Hyperglycemia Flashcards
Define Diabetes
A chronic multisystem disease related to
* Abnormal insulin production
* Impaired insulin utilization
* Or both
Diabetes is the leading cause of
- End-stage renal disease
- Adult blindness
- Nontraumatic lower limb amputation
Diabetes is a major contributing factor to
- Heart disease
- Stroke
Indigenous communities have a rate ______ general population
3-5x higher rate
How can personal health practices and coping affect a diabetes diagnosis
If diagnosed, progression can be delayed with good habits
How does sex play a role in the incidence of diabetes?
CAD risk amongst type 2 diabetics impact female > male
Etiology of diabetes
- Genetic
- Autoimmune
- Viral
- Environmental
Types of Diabetes
Two most common types
* Type 1
* Type 2
Other types
* Gestational
* Prediabetes
* Secondary diabetes
What produces insulin
- Produced by the cells - Islets of Langerhans
Explain the release of insulin
Released continuously into bloodstream in small increments with larger amounts released after food
What range does insulin normally stabilize blood glucose to?
4 to 6 mmol/L
What does insulin promote?
glucose transport from bloodstream across cell membrane to cytoplasm of cell
Decreases glucose in the bloodstream
What A1C test is diagnostic of diabetes
> 6.5
Why can A1C test show glucose levels over the last 3 months?
Shows the amount of glucose attached to hemoglobin molecules over RBC life span which is
approximately 120 days
8 Clinical Manifestations of Diabetes
- polyuria
- polydipsia
- polyphagia
- elevated BG
- blurred vision
- weight loss
- weakness/fatigue
- abdominal cramping
Treatment of hyperglycemia (5)
- assessment and reassessment of if this is an existing or new diagnosis
- insulin reassessment of dose (SC/IV)
- fluids oral or IV
- BG monitoring
- monitor for acute complications
What causes DKA
profound insulin deficiency
What type of diabetes usually sees DKA
Type 1
What 4 things characterize DKA?
- hyperglycemia
- ketosis
- acidosis
- dehydration
Why does hyperglycemia and ketosis characterize DKA
(r/t impaired secretion of insulin, glucose sits in vessels, body must break down fat leading to ketosis)
Why does acidosis characterize DKA
high ketones which drive down patient’s pH, leading to metabolic acidosis
Why does dehydration characterize DKA
Body attempting to correct a-b balance
Precipitating Factors of DKA (7)
- Illness
- Infection
- Inadequate insulin dosage; patients rationing doses
- Undiagnosed type 1; come in with extreme sugars
- Poor self-management/neglect
- Change in diet, insulin or exercise regimen
- Stress
Early signs and symptoms of DKA are associated with
Lack of perfusion r/t lack of circulating volume (dehydration)
Signs and Symptoms of DKA
- lethargy/weakness
- BG > 11.1
- dehydration - poor skin turgor
- dry mucous membranes
- tachycardia
- orthostatic hypotension
- sunken eyes
Lab pH expectation of DKA patient
< 7.35 (acidic)
Urinalysis expectation DKA
Ketone spill
Electrolyte expectation for DKA labs
Hyperkalemia early
Hypokalemia can occur with insulin therapy
Remainder of electrolytes can be depleted with dehydration
What are kussmauls respirations and why are they seen in DKA
- Rapid deep breathing – body is trying to get rid of acid by blowing off CO2 to increase pH
- Attempt to reverse metabolic acidosis
- Sweet fruity odour
Why is abdominal pain seen in DKA
Gastroparesis associated with ischemia to mesentry
ABC PRIORITY assessments for DKA
- airway and O2 admin r/t kussmauls
- LOC + VS
- hydration status + IV access
- electrolytes + BG monitoring
Fluid resuscitation for DKA - solution and purpose
IV infusion 0.45% or 0.9% NaCl
* Restore urine output
* Raise blood pressure
How does fluid therapy change when BG levels approach 13.8 in DKA patients?
- 5% dextrose added to regimen
- To prevent hypoglycemia- avoid rapid drop in blood sugar levels
Why can IV potassium replacement be necessary in DKA patients?
- Insulin drives potassium into the cells which can cause …
- Potential hypokalemia – why don’t we like this?
- Differentiation in potassium levels can cause arrhythmias
When is IV insulin administration started?
only AFTER fluid resuscitation
Describe IV insulin administration
- after fluid resuscitation
- slow careful continuous infusion
- hourly BG or more often
- SC insulin when patient is taking oral fluids and ketone spill in urine stops
Nursing Management of DKA patient
- Monitoring during administration
- subjective assessment
- objective assessment
What will be administered to DKA patient that nurse will have to monitor/manage?
- IV fluids
- Insulin therapy
- Electrolytes
What subjective information is key in management of DKA patient?
- History or DM
- Nutrition/pharma hx
What objective information is key in management of DKA patient?
- Renal status (output)
- Full Cardio/Resp assessment
- Breath sounds
- Cardiac rhythm (monitor)
- Level of consciousness (r/t glucose impairment)
- Other systems?
- N/V – abdominal
- Hydration status
4 Points of Evaluation for DKA patient
- Pt will achieve glucose control
- Avoid common complications from diabetes
- Remain free from foot lesions, infections and deformities
- Have decreased episodes of DKA
