Week 4 Diabetes Flashcards
Normal Eating
- Secrete insulin
- Glucose moves from blood into cells
Normal Fasting
- Basal insulin release
- Glucagon release when BG low
- Liver secretes glucose
Diabetes Eating
- Insulin excretion/use disrupted
- Glucose isn’t broken down to be usable
Type 1 (T1D)
- Complete lack of insulin in body
- Autoimmune
- Genetic component
Type 2 (T2D)
- Insulin resistance
- Metabolic syndrome (hypertension, obesity etc)
- Acquired illness
Symptom Assessment
- Signs of high or low blood sugar
- Fluid volume deficit
Symptoms of Diabetes
- Neurocognitive - dizziness/confusion
- Polydipsia
- Weight - loss
- Hungry
- Polyuria
Hyperglycaemia Complications
- Glucose damages vessels
- Atherosclerosis & poor perfusion
- Damages many body systems including nervous
Ocular Complications
- Damage to micro-vessels in eye
- Blindness, blurred vision
Cardiac Complications
- Atherosclerosis
- Increased risk of MI, CAD, stroke, HTN
Renal Complications
- Damage to nephrons
- Increased risk of chronic kidney disease
- Neuropathy in bladder
- Neurogenic bladder, UTI
Vascular Complications
- Peripheral vascular disease
- Peripheral neuropathy
- Poor wound healing
- Numbness feet/hands
- Falls risk
- Mobility
- Foot ulcers
Immune System Complications
- Impaired perfusion - limits movement of immune cells to infection sites
- High blood glucose is breeding ground for infection
- Decreased neutrophil synthesis
- Risk of septic shock
Integumentary Complications
- Impaired wound healing
- Impaired immunity
Critical BG Levels
<2.8mmol/L
>20mmol/L
Normal BG Levels
- Random <7.7mmol/L
- Fasting 4.0-7.0mmol/L
- HbA1C <6.5%
Diabetic BG Levels
- Random >11.1mmol/L
- Fasting >7.0mmol/L
- HbA1C > 6.5%
Hemoglobin A1C (HbA1C)
- Amount of glucose attached to Hb
- Reflects average serum glucose level over previous 2-3 months
- High = poor control of diabetes
Acute Hypoglycemia
- Development of autonomic & neuroglycopenic symptoms
- Low plasma glucose < 4.0mmol/L
- Symptoms that respond to carbs
Acute Hypoglycemia Causes
- Too much insulin/oral antihyperglycemic agents
- Inadequate food intake
- Excessive physical activity
Autonomic (Neurogenic) S&S
- Trembling
- Palpitations
- Sweating anxiety
- Hunger
- Nausea
- Tingling
Neuroglycopenic S&S - elderly/very severe hypoglycemia
- Poor concentration
- Confusion
- Weakness
- Drowsiness
- Vision changes
- Speech issues
- Headache
- Dizziness
Mild Hypoglycemia
- Autonomic symptoms
- Able to self-treat
- 2.8-4.0mmol/L
Moderate Hypoglycemia
- Autonomic & neuroglycopenic symptoms
- Ability to self-treat
- 2.8-4.0mmol/L
Severe Hypoglycemia
- Autonomic & neuroglycopenic symptoms
- <2.8mmol/L
- Unconsciousness may occur
Mild-Moderate Hypoglycemia Treatment
- Oral ingestion of 15g of carbs
- Retest BG in 15 mins
- Re-treat with another 15g of carbs if BG levels remain <4.0mmol/L
Severe Hypoglycemia Treatment Conscious
- Oral ingestion of 20g carbs
- Retest BG in 15 mins
- Re-treat if BG level remains <4.0mmol/L
Severe Hypoglycemia Treatment Unconscious
- IV access (Pre-established) IV push D5W (20-50mL) over 1-3 mins
- No IV access - SC/IM glucagon 1mg
Hypoglycemia Recovery
- BG > 4.0
- Monitor closely
- Eat usual meal/provide additional snack
- Causes??
Hypoglycemia Electrolyte Caution
- Body releases adrenaline when in hypoglycemia
- Causes rapid uptake of K into cells
Hyperglycemia
- High plasma glucose
- T1D less tolerant than T2D
- Not enough insulin/lack of effective stimulation
Diabetic Keto Acidosis
- T1D hyperglycemia emergency
>13.9mmol/L
Hyperglycemic Hyperosmolar Syndrome
- T2D hyperglycemia emergency >33mmol/L
Early Hyperglycemia Signs
- Tiredness
- Polyurea, dehydration
- Polydipsia
T2D Diet Teaching
- Healthy fats
- High fiber carbs
- Eat a bedtime snack
Insulin Considerations
- Check BG prior to admin
- Admin amount based on sliding scale
- Give food during insulin peak
- No mixing long acting with other types
- Draw clear (regular) then cloudy (NPH)
Rapid Insulin
- Onset 15mins
- Peak 30-90mins
- Duration 3-4hrs
Short Acting Insulin
- Peak 2-3 hrs
- Duration 4-6 hrs
- 20-30mins before meal
Intermediate Insulin
- Peak 4-12 hrs
- Duration 16-20hrs
- Post meal
Long Acting Insulin
- No peak
- Duration >24 hrs
- Basal dose
Oral Antihyperglycemic Agents
- T2D only
- Diet & exercise first
- Avoid Iron, calcium - poor absorption
Metformin
Treat hyperglycemia, lower BG
Metformin Side Effects
- Stomach pain
- GI upset
- Gas
- Bloating
- N/V/D
- Constipation
Metformin Nursing Considerations
- Monitor BG - hypoglycemia risk
- Potentially hepatotoxic - monitor ALT & AST
- Contraindicated in eGFR <30
- Hold before contrast dye
Glyburide
Treat hyperglycemia, lower BG
Glyburide Side Effects
- GI upset
- Skin reactions - sunscreen
- Weight gain
Glyburide Nursing Considerations
- Monitor BG - hypoglycemia risk
- Avoid EtOH - risk of hypo
- Lower alcohol intake
- Hypo symptom teachings & actions
- Caution with heart failure/MI
Rosiglitazone, Pioglitazone
Treat hyperglycemia, lower BG
Rosiglitazone Side Effects
- Weight gain
- Edema
- Macular edema
- Heart failure
Rosiglitazone Nursing Considerations
- Monitor BG - high risk of hypo
- Potentially hepatotoxic
- Increased risk of bladder CA of genetic origin
Acarbose
Treat hyperglycemia, lower BG
Acarbose Side Effects
- Gas
- Diarrhea
- Bloating
- Stomach pain
- GI upset
- NV
Acarbose Nursing Considerations
- Monitor BG - hypo risk
- Avoid in clients with GI issues (IBS, Crohn’s)
Levothyroxine (Synthroid)
Treats hypothyroidism
Levothyroxine Side Effects
- Fever/hot flashes
- Sweating
- Nervousness
- Irritability
- NVD
- Headache
- Insomnia
Levothyroxine Nursing Considerations
- Monitor toxicity
- Risk of hyperthyroidism
- Tachycardia, chest pain, palpations
- Take in morning without food
- Avoid calcium & iron
- Avoid fluctuations in thyroid levels
Hyperthyroidism Treatment
- Oral iodine
- Destroys thyroid hormone
- Attaches to hormone & helps excrete
