SubQ IVP DIabetes Flashcards
what is diabetes the leading cause of
heart disease stroke blindness limb amputation HTN End Stage renal disease
what is the average amount of insulin a person produces in a day
40-50 units
the two primary functions of insulin and an additional function
pulls glucose into the cell
facilitates glucose storage to glycogen
and it inhibits the breakdown of stored glucose from proteins and fats
what triggers the onset of type one diabetes
usually a viral infection- triggers the persons immune system to start attacking the beta cells of the liver
what are the signs and symptoms of Type one diabetes
3 Ps
Polyuria-
Polydipsia- (d/t dehydration state)
polyphagia-(caused from the cell malnourishment from not getting glucose)
Eventually will lead to DKA if left untreated
what are the signs and symptoms of type 2 diabetes
often subtle and go unnoticed for years. 3 P's polyuria polydipsia polyphagia
also infection including vaginal and yeast infections., prolonged wound healing(d/t hyperglycemia effect on WBC, visual changes, and fatigue
what is the normal glucose range
70-110
but in a diabetic pt we are looking for glucose control from 70-130
what are the hormones that oppose the effects of insulin
glucagon- hormone that breaks down glycogen to glucose
epinephrine- causes vasospasm which maintains BP
growth hormone- promotes cell division and protein synthesis
coristol-suppressess immune system- increases blood sugar
when should you assess urine for keytones in urine
when blood glucose is >240
when should you notify the MD about high blood glucose
when the blood glucose is >300 and is unable to take in fluid and foods.
what are the symptoms of hypoglycemia
cold clammy sweaty pale hungry tachy tremors anxious headache visual disturbances slurred speech
Severe:
changes in LOC
Seizures
what can be the cause of hypoglycemia
Alcohol- it inhibits glycogenolysis
not eating enough food
drinking without eating
too much diabetic medication
too much exercise without compensation of food.
a hyperglycemic pts blood glucose dropping too quickly
what do you want to avoid when trying to correct hypoglycemia
don’t give CHO with fats because the fats slow down he digestion.
what do you want to give a pt who is suffering from hypoglycemia
a simple CHO such as fruit juice or soda
and then recheck the blood glucose 15 minutes later
what is treatment for diabetes
TIGHT GLUCOSE CONTROL monitor Hbg A1c, blood glucose and renal panel insulin replacement diet and exercise hospitalize education sick day treatment monitor for s/s of hypoglycemia
how does DKA develop
usually seen in type 1. the cells are starved for glucose so they kick start gluconeogenesis which synthesizes glucose from fat. the fat breaks down to glycogen and fatty acids. the glycogen breaks down to glucose and the fatty acids break down and as a by product releasing keytones.
the rising blood glucose results in osmotic diuresis increasing the loss of fluid and electrolytes which leads to hypovalemia and shock leading to renal failure causing retention of keytones and glucose. the rising keytones cause a decrease in the pH causing an acidic environment causing vomiting increasing the loss of electrolytes
what can happen if DKA is untreated
extreme dehydration and electrolyte depletion and eventually death death
how much fluid loss results from osmotic diuresis
6L
about 15% of total body water over 24 hours
what are signs and symptoms of DKA
3 P's polyuria, polydipsia, polyphagia lethargy dehydration abd pain anorexia vomiting tachy hypotension (hypokalemia) KUSSMAUL RESPIRATIONS SWEET SMELLING BREATH pH <7.30
what lab findings are consistent with DKA
BG >250 arterial pH <7.30 Bicarb <15 keytones in blood and urine electrolyte imbalance high anion gap
what are the priorties of Tx of diabetes
FLUID REPLACEMENT =#1
when glucose levels fall to 250 you may add glucose to prevent hypoglycemia
IV insulin REGULAR INSULIN ONLY- 50mg/dL/ hr
K+ replacement (initially K+ levels may be normal or high but once the fluid replacement and IV insulin- the insulin promotes K+ back into the cell causing hypokalemia)
what do we need to monitor w/ DKA
LOC vitals labs I&O Cardiac monitoring s/s of cerebral edema (caused from hyponatremia)
what is HHS
hyperosmolar hyperglycemic syndrome
found in pts who make enough insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis and ECF depletion
what are the signs and symptoms of HHS
few symptoms in the beginning dehydration hypotension tachycardia altered LOC later signs: glucose levels of 600-1200 little to no keytones in urine electrolyte imbalances
dehydration leads to neurological symptoms
coma, seizure, hemiparesis and death
what medications are used for diabetic nephropathy
Ace inhibitors and angiotensin II antagonists because
they control BP but also slow the progression of nephropathy
what other eye complications can come from diabetes besides retinopathy
glaucoma
cataracts
retinal detachment
what should BP , LDL, HDL and triglyceride levels be in a diabetci
BP-<130/80
LDL- < 100
HDL- >40
triglycerides <150
