How can hormones like adrenaline or cortisol effect insulin?
These hormones counter the effect of insulin, sometimes triggering diabetic ketoacidosis. Corticosteroids (containing cortisol) or illnesses like PNA or UTIs can cause increase of cortisol release
List these levels of someone who is in diabetic ketoacidosis:
What will you find in urine or blood?
Bicarb: <18 mEq/L
Moderate to large ketones in the urine or blood
What is the first intervention for diabetic ketoacidosis? Second?
2nd: Correct fluid and electrolyte imbalances
What is an important consideration when controlling BG of a DKA patient? Which type of IV fluid would you use first?
Can't BG down too fast (can cause edema, brain damage, etc)
Initially use an isotonic fluid (NS 1L over 30-60 mins)
After giving O2 to a DKA patient, which symptom do you need to consider when prioritizing orders?
Make sure to correct dehydration first. Remember that an isotonic solution will be first used, with possible 5% dextrose added to prevent hypoglycemia rebound, then eventually a hypotonic solution to rehydrate the cells
What other electrolyte will be added as part of cells becoming dehydrated and then being rehydrated?
As you rehydrate cells, K+ will dip down
During DKA, when is insulin therapy initiated?
How is insulin administered initially and followed up with DKA tx?
Bolus via IVP, then IV drip, which gets titrated as BG changes
How will insulin effect water and potassium in the vascular system?
Insulin will allow glucose to enter the cells, which is followed by water and K+. This will lead to depletion of vascular volume and hypokalemia
You are interviewing a patient who is 6', 260lbs. and has no energy. He is concerned that he might have diabetes. You should:
Why will a nurse initiate cardiac monitoring for a patient with DKA?
Electrolyte are depleted in DKA (Na, K, Cl, Mg, Phosphate). This will include K+, which can lead to hypokalemia and present the patient with dysrhythmias (ventricular complexes and bradycardia)
T or F: T2 Patients in HHS go into anaerobic metabolism
False: T2 diabetics release just enough insulin where they don't go straight into anaerobic metabolism.
These infections are common causes of HHS with T2
(newly dx T2)
Which one will need a higher fluid replacement: DKA or HHS
HHS d/t higher osmolarity rate
A person with HHS should have their BG taken down ___/hour
Elderly patients who use Beta-adrenergic blockers are at risk for hypoglycemic or hyperglycmia?
What will be given to patients in a hypoglycemic emergency?
Quick acting carbo and one long acting one as well:
or 50% glucose IV
IV or subq inj of glucagon
Make sure to recheck in 2 hours to assess liver fxn
What is Acanthosis nigcricans and what is the most common cause?
A skin condition characterized by dark, velvety discoloration in body folds. Typically occurs in people who are obese or have diabetes (commonly T2)
Necrobiosis lipiodica is associated with type __ diabetes. It is characterized by ____.
How often do you check for these?
2. Eye exam
3. Kidney fxn
4. feet neuropathy test
5. Cholesterol screening
6. BP eval
The rest = yearly
Hypoglycemic between 2-4am and then an increased BG in the AM:
b. Dawn effect
For Somogyi tx, would you increase or decrease PM insulin? Why?
Decrease PM insulin to let BG go higher at night.
Simogyi: hypoglycemic between 2-4a and then an increased BG in the AM
Wake up with sweats, HA, and nightmares then hyperglycemia:
b. Dawn Effect
b. Dawn effect
For Dawn effect, would you increase or decrease PM insulin? Why?
Increase: Dawn effect is an abnormal increase in BG between 2-8am. Increasing insulin at PM will counteract this
This diabetic drug has a potential of causing kidney injury with CT contrast
This is the first-line medication for type 2 diabetes
What is the action of Biguanides (Metformin)?
Reduce hepatic glucose output and increase uptake of glucose