part 3

Question 1

What are ketones?

Answer 1

by products of fat breakdown and they accumulate in the blood and urine

Question 2

What do ketones in the urine signal?

Answer 2

deficiency of insulin and control in type 1 DM is deteriorating

Question 3

When should ketone testing be performed?

Answer 3

when pt’s with T1DM have glycosuria or blood glucose of more than 240 for 2 testing periods in a row , during illness, pregnancy with preexisting diabetes, and gestational diabetes

Question 4

What can cause hyperglycemia in the morning?

Answer 4

Somogyi effect

Question 5

What is the danger of the somogyi effect?

Answer 5

• giving too much insulin before bed can cause hormones to have a rebound effect with eventually raises glucose (rather than lowering) during the night
• then giving more insulin in the morning can cause hypoglycemia

Question 6

What should you do if a pt is experiencing increased blood glucose first thing in the morning (somogyi effect)?

Answer 6

• check to see if the pt has hypoglycemia between 2 and 4 in the morning
• if pt does this is somogyi effect

Question 7

What is some subjective information the pt may report if they have somogyi effect?

Answer 7

• headache when they wake

- night sweats or nightmares

Question 8

What can help prevent somogyi effect?

Answer 8

• bedtime snack
• reduction in dose of insulin
• or both

Question 9

• High dose of insulin at night (long acting)
• develop late night (3-4 AM) hypoglycemia
• counter regulatory will increase
• this causes early morning hyperglycemia
• Tx: reduce long acting insulin at night

Answer 9

Somogyi phenomenon