Type 1 Diabetes and DKA Flashcards
What is DMT1?
its an autoimmune disease involving the destruction of beta cells in the pancreatic islet of Langerhans in the pancreas, where insulin is produced
Risk factors of DMT1
- genetic predisposition
- viral environmental exposure that triggered and autoimmune response
- family history
- age (usually 4-6 yrs or 10-14 yrs but can happen at any age)
Complications of DMT1
- stroke
- heart attack
- peripheral artery disease
- diabetic neurophathy
- cataracts
- glaucoma
- diabetic foot
- diabetic nephropathy
- peripheral neuropathy
- diabetic ketoacidosis
Manifestations of DMT1
**rapid onset manifestation
* polyuria
* polydipsia
* polyphagia
* weight loss
* visual changes **
- repeated infections
- delayed wound healing
- numbness and tingling in feet and hands
*
DKA what is it?
- Diabetic Ketoacidosis
- lack of insulin
- blood glucose of 300mg/dL or more
- Occurs in type I , rare in type II
Expected findings of DKA
- 3 P’s
- weight loss
- GI effects (n/v, abdominal pain
- blurred vission
- headache
- weakness
- orthostatic hypotention
- fruity odor to breath
- Kussmaul Respirations
- metabolic acidosis
- mental status change
What are some lab values shown in DKA?
- Blood glucose 300 or higher
- sodium can be normal high or low
- potassium elevated initially the falls
- BUN and creatine increased
- ketones present in blood and urine
DKA treatment
- vital signs every 15 minutes
- rapid 0.9% sodium chloride infusion for first 1-3 hrs
- administer regular insulin (IV bolus/continous)
- monitos electrolytes
- replace electrolytes as needed
- monitor cardiac rhythm
- monitor LOC
Patient education for DKA
- Medial alert bracelet
- Decrease risk of dehydration
- Monitor BG q 4hrs when ill
- Check urine ketones when ill
- Consume carbohydrate liquids
when unable to eat solid foods. - When to notify HCP
- Illness >24 hrs
- BS >250 mg/dL
- Inability to eat/drink
- Urine ketones >24 hrs
- Temp of 101.5 >24 hrs
When to notify HCP?
- Illness >24 hrs
- BS >250 mg/dL
- Inability to eat/drink
- Urine ketones >24 hrs
- Temp of 101.5 >24 hrs
DMT1 impact on health
- linked to lower life expectancy
- increased risk of having unstable blood glucose levels
- weight loss and muscle wasting
- anxiety
- depression
- sleep disturbances
- dermatological conditions- prone to skin irritation and bacteria or fungal infections
what to expect with DKA
Blood glucose greater than 300 mg/dL
* Blood beta-hydroxybutyrate level is elevated
* Serum ketones present
* Blood gas pH less than 7.3
* HCO³ of less than or equal to15 mEq/L (Bicarbonate ↓)
* Urinalysis: positive for glucose and ketones
* anion gap is more than 10
DMT1 labs
- non-fasting blood glucose 200mg/dL
- fasting-126mg/dL or greater
- HbA1c 7% or greater
- urinalysis shows elevated glucose or acetone levels
- C-peptide levels are decreased
Factors to consider
**Individual **: consider what device meets their needs in terms of usability and cost. coordinate with insurer
Environmental: changes in temperature may affect metabolism. Dehydration may lead to increase of blood glucose. Lack of access to resources
What is the role of the nurse?
To manage disease and prevent complications
* review lab results
* monitor vital signs
* medication administation
* initiate and facilitate referrals to endocrinologists and other services
* skin and wounds care
What should nurse fo if DKA occurs?
expected to provide complex nursing care to support hydration, monitor and replenish electrolytes, and treat acidosis is required
CLIENT EDUCATION FOR DMT?
- How to monitor blood glucose levels
- self administartion of insulin
- close monitoring during times of stress and illness
- Certain circumstances will require them to know how to self-test for urine ketones
- recognize and treat hypoglycemia
- dietary recommendations and facilitate referral to nutritionist
- screening for complicationsof visual impairment and foot complications
- daily foot care
what to teach about daily foot care?
- daily cleansing is required with warm water
- make sure to dry feet properly
- apply lotion to top and botton of feet
- Do not apply lotion in between toes as this may lead to infection
- Always wear footwear to decrease risk of wounds
- Properly fitted shoes are necessary for optimum foot health
- need regular podiatry visits for foot and nail care.
what should nurses assess for DMT1
- glycemic control
- presence of complications
- blood glucose and HbA1c results
- visual changes, signs of infection, and wound problems
- manifestations of DKA: mental status change, n/v, increase RR, abdominal pain, dehydration, electrolyte abnormalities
What should nurses prioritize
- glycemic emergencies
- hypoglycemia
- hyperglycemia
- Organize care around problems that are most dangerous in the short term
What solutions should the nurse plan?
- optimize glycemic control
- prevent long term complications
- manage emotional stressors
- support on how to simplify a treatment regimen, access to mental health counseling, optimize the use of technology
If the following occurs during illness the client should go to the emergency room:
- Weight loss of more than 5 lbs
- Inability to keep down fluids for over 4 hours or food for over 24 hours
- Moderate to high ketone levels in urine
- Temperature greater than 38.3° C (101° F)
- Vomiting or diarrhea lasting longer than 6 hours
- Presence of dyspnea, confusion, or change in behavior
What are some interventions a nurse can provide?
- administer insulin
- provide education on self-administration of insulin
- coach on how to perform blood glucose checks, administer insulin, and monitor for low and high levels.
- If complications related to neuropathy, infection, and wound healing occur, provide additional education and wound care
What are the glycemic targets?
HbA1c: less than 7%
preprandial blood glucose: 80-130mg/dL
Treatment and therapies for DMT1
- Monitor blood glucose
- administer injectable insulin(pen,vial,pump)
- Monitor HbA1c
- eye exams: for development of diabetic retinopathy and completed anually or when vision changes occur
- foot examinations- performend frequently to identify wounds or sores to avoid amputation
- proper nutrition
- regular exercise routine
*
Rapid acting insulin
- Begins working within 15 to 30 min
- lasts about 3 to 5 hr.
- Peak:30 min to 3hrs
Insulin aspart (NovoLog)
Insulin glulisine (Apidra)
Insulin lispro (Humalog)
Short acting insulin
- Begins working within 30 to 60 min
- lasts about 4 to 12 hr
- Peak : 2 to 4 hrs
Human regular (Humulin R, Novolin R)
Intermediate-acting insulin
- Begins working within 1 to 2 hr
- lasts about 14 to 24 hr
- Peak: 4 to 12 hrs
NPH (Humulin N, Novolin N)
Long-acting insulin
- Begins working within 2 to 4 hr
- lasts up to 24 hr
- Peak: minimal
Detemir (Levemir)
Glargine (Lantus)
