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What is Type I DM?
- autoimmune disease
- Juvenile DM, IDDM (insulin dependent DM). Both terms are no longer used.
- Immune disorder response attacks Beta cells-->Loss of Beta cells-->NO insulin
- Emergent levels ~500-800.
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What is type II DM?
- insulin resistance or insufficiency
- Adult onset, NIDDM (Non-Insulin-Dependent DM). Again, neither one is really used anymore.
- More common than Type 1
- Obesity, esp abdominal/visceral; genetic
- Insufficient insulin production &/or poor utilization (e.g. insulin resistance)
- Emergent levels ~800-1600.
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What labs are necessary to diagnose DM?
- Hgb A1C >6.5
- FPG >126 mg/dL
- 2o PG >200 mg/dL
- w/classic hyperglycemia (3 Ps & wt. loss), or crisis, random PG >200 mg/dL
- FPG=Fasting Plasma Glucose
- 3 P's=Polydipsia, polyurea, polyphagia.
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Treatment of DM
- Lifestyle modification, ie v sugar intake and ^exercise.
- Insulin, esp with type I.
- Oral agents
- Prevent/tx complications
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SnSs of Type I DM
- Polyuria, Polydipsia, Polyphagia
- DKA (Diabetic Ketoacidosis): Hyperglycemia, ketosis, acidosis, dehydration
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SnSs of type II DM
- Nonspecific, asymptomatic, fatigue, and possibly 3p's.
- HHS (Hyperosmolar Hyperglycemic Syndrome): Hyperglycemia and severe neurologic changes
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What are some Nursing Intervensions for pts w/
- DKA (type I), HHS/HHSK (hyperosmolar hyperglycemic syndrome/hyperosmolar hyperglycemic nonketotic) syndrome.)
- Fluid resuscitation, e-lyte replacement, insulin, glucose
- Vitals
- Labs
- Cardiac monitor
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What is the emergency response for hyperglycemia?
- In emergent situations, it does not matter if pt is hyperglycemic due to type I or type II. Treatment will be the same either way.
- Large bore (16-18gauge) IV fluid, ie .9% NS
- CMP
- CBC
- Hbg A1C value
- Slow IV insulin admin, as glucose levels approach normal, can switch NS to 5DW to help prevent hypoglycemia.
- Possibly antibiotic
- Cardiac monitoring
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Possible DM complications
- Angiopathy (blood vessel damage)
- Micro/macrovascular damage
- Diabetic retinopathy
- Nephropathy
- Neuropathy
- Feet/LE
- Foot care
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Tx for hypoglycemia?
- Give sugar, ie 15-20 g simple carbs
- Glucose check
- Recheck glucose after giving sugar
- More complex carbs and proteins.
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