Acute Complications of DM

Mourning hyperglycemia from a counter-regulatory response to night time hypoglycemia

• less insulin
• check blood sugar b/n 2 & 4am
• if b.s is low reduce am insulin

hyperglycemia from a nighttime release of growth hormone that causes b.s elevations at about 5am to 6am

• change in timing of dose (later)
• more insulin & bedtime snack
• check b.s b/n 2 & 4am

• TYPE I Problem
• Profound defiency of insulin
• BS>300
• Dehydration
• Fruity breath
• Kussmaul Respirations
• anorexia
• n/v (metabolic acidosis)
• weakness, lethargic
• electrolyte imbalance
• lead to coma
• death

• Continuous IV infusion of insulin
• I/V hydration w/ NSS initially
• electrolyte replacement

• TYPE II Problem
• produce enough insulin to prevent DKA
• not enough insulin to prevent hyperglycemia, osmotic diuresis or ECF depletion
• Inc in serum osmolarity
• BS>400
• ketones are absent

• medical emergency
• IV NSS or 1/2 NSS
• IV Reg Insulin
• BS below 250 add IV Glucose (D5 1/2)
• Electrolyte Replacement
• Cardiac Monitoring (high K)

loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in insulin

injection of insulin at the edge of the atrophied area

increased swelling of fat that occurs at the site of repeated insulin injection

rotating injection injection site among different body areas