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Diabetes Mellitus (DM)
- A disease of altered relationships between glucose and insulin.
- Either a lack of insulin being secreted by the pancreas or the inability of the cell receptors to recognize the insulin and allow glucose to enter at a normal rate.
- Patients usually complain of thirst (polydipsea), frequent urination (poly uria), and is typucally hungry(polyphagia).
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Glucose
- A form a sugar that's the body's basic source of energy.
- Since glucose draws H2O with it, giving glucose to a stroke or head injury patient will lead to swelling of the brain cells, increase edema and worsen the situation.
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Insulin
- A hormone that promotes the movement of glucose from the blood into the cells.
- Increases the movement of glucose out of the blood and into the cells.
- Causes the liver to take up glucose out of the blood and convert into glycogen for storage.
- Decreases blood glucose level (BGL)
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Glucagon
- A hormone that stimulates the liver to convert stored glycogen and other substances into glucose.
- Converts glycogen stored in the liver back into glucose and releases it into the blood.
- Converts other non carbohydrate substances into glucose.
- Increases BGL.
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Epinephrine (Adrenaline)
Stops secretion of insulin and promotes the release of stored glucose
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Normal Metabolism and Glucose Regulation
- Normal range 70-120mg/dL
- 120-140mg/dL after a meal
- Glycogen in the liver can last up to 24-48hrs
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Hypoglycemia
- Low blood glucose.
- A blood glucose level of 60mg/dL with signs or symptoms of hypoglycemia or of less than 50mg/dL with or without signs or symptoms of hypoglycemia.
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Hyperglycemia
- High blood glucose.
- A persistant blood glucose level greater than 120mg/dL.
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Testing BGL with a Glucose Meter
- Glucose meter
- Glucose meter test stripes
- Lancet
- Alcohol swabs
- 1. Prepare the lancet and lancet device
- 2. Let the arm hang down at the patient's side if possible
- 3. Remove a new test strip from the vial. Insert the test strip.
- 4. Match the code number
- 5. When the blood drop symbol flashes on the LED screen
- 6. Grasp the finger near the site to be pricked (make sure the alcohol dries completely)
- 7. Keeping the hand downward, prick the side of the fingertip, squeeze the first drop out and use the second drop for testing
- 8. Drop the blood onto the specific area of the test strip
- 9. The value will be displayed
- 10. Remove the strip into a biohazard container
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Type 1 Diabetes
- Condition in which the pancreas typically does not secrete any insulin; insulin-dependent diabetes mellitus (IDDM)Typically develops during a younger age
- Less common than type 2
- Due to lack of insulin secretion, type 1 is more prone to diabetic ketoacidosis(DK)
- May suffer from hypoglycemia
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Type 2 Diabetes
- Diabetes that can be regulated by diet, exercise, and drugs other than insulin; non-insulin-dependent mellitus(NIDDM)
- Usually middle-aged or older
- Prone to hyperglycemic hyperosmoler nonketotic syndrome(HHNS)
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Hypoglycemia
- Epinephrine is released, therefore patients with hypoglycemia may have tachycardia, diaphoresis, and pale cool skin
- Weakness
- Hunger
- Dizziness
- Warm sensation
- Confusion
- Disorientation
- Seizures
- Stroke like symptoms
- Always ensure open airway
- Nonrebreather mask 15lpm if cannot administer oral glucose
- PPV if inadequate breathing
- Contact ALS
- If the patient is responsive, able to swallow, and able to obey commands, administer oral glucose
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Oral Glucose
- A form a sugar often given as a gel, by mouth, to raise the BGL
- Only can be administered if:
- 1. patient has altered mental status
- 2. has a history of diabetes controlled by medication or a BGL reading less than 60mg/dL
- 3. has the ability to swallow
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Diabetic Ketoacidosis (DKA)
- BGL usually above 350mg/dL
- 3Ps
- Tachycardia
- Nausea/vomiting
- Fruity or acetone odor on the breath
- Poor skin turgor
- Rapid deep respiration
- Muscle cramps
- Abdominal pain
- Warm, dry, flushed skin
- Altered mental statutus
- 1. Maintain airway
- 2. PPV if needed and O2
- 3. Administer glucose if able to
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Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
- BGL usually 600-1200mg/dL
- Tachycardia
- Fever
- Dehydration
- Dizziness
- Poor skin turgor
- Weakness
- Altered mental status
- Confusion
- Dry oral mucosa
- Dry, warm skin
- 1. Maintain airway
- 2. PPV and O2 if needed
- 3. Administer glucose if possible
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Medications Usually taken by Diabetics
- Insulin(humilin, novolin, iletin, semilente)
- Actos
- Diabenese, Glucamide
- Orinase
- Micronase, DiaBeta
- Tolinase
- Glucotrol
- Glynase
- Exenatide(Byetta)
- Lantus
- Exubera
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