Lecture 7 Diabetes Flashcards
hypoglycemia symptoms
shaky, dizzy, nervous, sweating
hungry
pale
clumsy
headache
confusion, inattention
tingling
fainting
hyperglycemia symptoms
dehydration - thirsty
polyphagia, polydipsia, polyuria
tired and weak
blurry vision
hypoglycemia
blood glucose <70 mg/dL
severe hypoglycemia
blood glucose <40 mg/dL
causes of hypoglycemia
too much insulin or oral anti diabetic meds
too little food
excessive physical activity
treating hypoglycemia
15 g carbs orally if able to swallow
recheck blood glucose in 15 minutes
15 g carbs again if glucose <70
glucagon injection or D50 IV
hyperglycemia
blood glucose >250 mg/dL
causes of hyperglycemia
insufficient insulin
missed doses of insulin
physical or emotional stress
illness or infection
complications from hyperglycemia
ketone production
rapid weight loss
impaired circulation
increased risk for infection
main clinical features of DKA
hyperglycemia
dehydration
acidosis
signs and symptoms of DKA
same as hyperglycemia
hypotension
dry skin, dry mucous membranes, flat neck veins
acetone breath
GI disturbances
kussmaul respirations
DKA blood glucose value
300 - 800 mg/dL
DKA serum pH
6.8-7.3
DKA serum bicarb
0-15 mEq/L
Where are ketones found?
serum and urine
DKA anion gap
positive anion gap
more positively charged ions (Na, K, Ca, Mg) than negatively charged ions (bicarb)
DKA treatment
IV insulin continuous
rehydration - NS
monitor VS and I/Os, signs of fluid overload
monitor potassium (insulin brings it into cells)
diabetes management when sick
- take meds as usual
- test BG and ketones every 3-4 hours
- report BG >300 or urine ketones
- substitute soft foods if unable to eat normal foods
- 1/2 cup of fluids every 30 minutes - 1 hour
Hyperglycemic Hyperosmolar Nonketotic Syndrome
life-threatening
> 340 mOsm/L
> 600 mg/dL blood glucose
ketosis absent or minimal
alterations in LOC
when is HHNS more common?
for patients with type 2 diabetes
causes of HHNS
infection, surgery, dialysis, illness
signs and symptoms of HHNS
hypotension
dehydration
tachycardia
neuro signs
treating HHNS
fluid replacement
correct electrolyte imbalances
IV insulin
what complication is more common with type 1 diabetes?
renal (microvascular) complication
what complication if more common with type 2 diabetes?
cardiovascular (macrovascular) complications
what are macrovascular diseases?
atherosclerosis of medium and large blood vessels
coronary artery disease
cerebrovascular disease
why can MI be “silent” with diabetes
lack of ischemic symptoms secondary to autonomic neuropathy
managing macrovascular disease
manage HTN, start on ACE or ARB if BP goal not met in 3 months.
statin for hyperlipidemia
81 mg aspirin
what is microvascular disease
thickening of the capillary basement membrane in the retina, kidneys, gums, and peripheral extremities
what happens from microvascular disease in the gums?
increased susceptibility to peridontal disease and cavities
what is the leading cause of blindness in the US before age 74?
diabetic retinopathy
what happens from vessel changes in diabetic retinopathy?
microaneurysms
intraretinal hemorrhage
hard exudate
signs and symptoms of diabetic retinopathy
blurry visionn
floaters
cobwebs
hazy vision
vision loss
how common is diabetic nephropathy?
occurs in 20-40% of patients with diabetes
leading cause of end stage renal disease
signs and symptoms of diabetic nephropathy
hypoglycemia
albumin in the urine
HTN
how prevalent is peripheral vascular disease?
2-3 times more common in diabetic patients compared to non-diabetic patients
signs and symptoms of peripheral vascular disease
diminished peripheral pulses
intermittent claudication
what happens with severe arterial occlusive peripheral vascular disease?
higher incidence of gangrene and amputation for people with diabetes
diabetic neuropathy
affects peripheral sensorimotor nerves AND autonomic nerves
signs and symptoms of peripheral neuropathy
aching or burning
numbness and tingling
decreased awareness of body and position
decreased sensation of light, pain, temperature
foot care for diabetic neuropathy
wear shoes and socks always
inspect feet every day
wash feet every day
protect feet from extreme temperatures
check with PCP right away with any concerns
