Lecture 7 Diabetes Flashcards by Isabel Ostroski

hypoglycemia symptoms

shaky, dizzy, nervous, sweating
hungry
pale
clumsy
headache
confusion, inattention
tingling
fainting

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hyperglycemia symptoms

dehydration - thirsty
polyphagia, polydipsia, polyuria
tired and weak
blurry vision

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hypoglycemia

blood glucose <70 mg/dL

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severe hypoglycemia

blood glucose <40 mg/dL

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causes of hypoglycemia

too much insulin or oral anti diabetic meds
too little food
excessive physical activity

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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

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hyperglycemia

blood glucose >250 mg/dL

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causes of hyperglycemia

insufficient insulin
missed doses of insulin
physical or emotional stress
illness or infection

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complications from hyperglycemia

ketone production
rapid weight loss
impaired circulation
increased risk for infection

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main clinical features of DKA

hyperglycemia
dehydration
acidosis

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signs and symptoms of DKA

same as hyperglycemia
hypotension
dry skin, dry mucous membranes, flat neck veins
acetone breath
GI disturbances
kussmaul respirations

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DKA blood glucose value

300 - 800 mg/dL

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DKA serum pH

6.8-7.3

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DKA serum bicarb

0-15 mEq/L

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Where are ketones found?

serum and urine

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DKA anion gap

positive anion gap

more positively charged ions (Na, K, Ca, Mg) than negatively charged ions (bicarb)

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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