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acute complications of diabetes
- hypoglycemia
- DKA
- hyperosmolar
- hyperglycemia syndrome(HHS)
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chronic diabetic complications
- -angiopathy(micro/macrovascular)
- -neuropathy
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hypoglycemia blood sugar
less than 70
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cause of hypoglycemia
- -too little food
- -too much insulin
- -too much exercise
- -alcohol
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hypoglycemic unawareness is r/t
autonomic neuropathy
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hypoglycemia s/s
- -confusion
- -irritable
- -diaphoresis(sweaty)
- -tremor
- -hunger
- -weak
- -visual
- -mimic being drunk
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if hypoglycemia is left untreated
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mild hypoglycemia
- -sweat and tremor
- -tachy and palpitation
- -nevous and hunger
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moderate hypoglycemia
- -poor concentration
- -numb of lips and tongue
- -headache and light headed
- -slurred speech
- -irrational/combative
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severe hypoglycemia
- -dissorientaion
- -diff to arouse
- -seizure
- -LOC
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hypoglycemia treatment
- -check sugar
- -if less than 70, begin treat
- -15g simple carbs, fast acting
- -glucose tabs per instruction
- -4oz juice
- -recheck in 15 min
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hypoglycemia treatment if no improvement in 2 or 3 doses
-notify HCP
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hypoglycemia treatment if pt can not swallow
- -1mg of glucagon IM or SQ
- se: rebound hypoglycemia
acute care setting: 20-50ml of 50% dextrose ampule iv push
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hyperglycemia cause
- -too much food
- -not enough insulin
- -stress
- -illness/infection
- -inactivity
- -steroids
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hyperglycemia s/s
- -frequent urination(polyuria)
- -thirst
- -fatigue
- -dry itchy skin
- -hunger
- -nausea
- -blurred vision
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hyperglycemia treatment
- -if over 250 call md
- -check sugar more feq
- -take meds
- -drink water
- -eat less cc meals
- -check urine for ketones
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type __ diabetics are at greater risk for DKA
1
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when to check sugars if excersising
- before and after
- do not excersise if over 20 and ketones are present
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DKA is caused by
profound deficiency of insulin
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DKA is charecturized by
- -hyperglycemia
- -ketosis
- -acidosis
- -dehydration(b/c of freq urination)
- -most likely in type 1
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DKA precipitating factors
- -illness/infrection
- -inadequate insulin
- -undiagnosed type 1
- -poor self management
- -stress
- -neglect
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DKA results in
- -hyperglycemia
- -ketosis
- -acidosis
- -dehydration
- -electrolyte imbalance
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dka patho
- -because of insuffcient insuline body cant use gluecose for energy
- -body compensates by breaking down fats
- -ketones are a byproduct of fat metabolism
- -ketones are acidic, alter ph which leads to metabolic acidosis
- -ketones when excreated: cause ketonuria(in urine), which causes electrolytes to be depleted so the body eliminates cationes and anionic ketones in order to maintain electrical neutality
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S/S of DKA
- -lethargic/weak
- -poor skin
- -dry mucos
- -tachycardia
- -ortho hypo
- -sunken eyes
- -abdom pain
- -anorexia
- -n/v(acidosis)
- -kussmall respirations
- -ketone breath
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during DKA kussmal respirations are a common symptom. what is this
rapid deep breathing associated with shortness of breath
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DKA labs
- glucose greater 250
- serum bicarb less 16
- artierial blood ph below 7.3
- ketones in blood and urine
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when does insulin treatment start after DKA is diagnosed
after potassium if hypokalemic
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why is it bad to give insulin if potassium is low
insulin depletes potassium
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three goals for DKA treatment
- -correct dehydration
- - correct electrolytes
- - correct acisosis
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what comes first with DKA treatment
FLUIDS!!!!!
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when starting fluid/electrolyte replacement with DKA pt
-0.45 or 0.9 Nacl to restore urine output to 30-60ml/hr and to raise BP
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with DKA when glucose level reaches____ what do you add to iv therapy
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why do you add 5-10% dextrose to iv with dka pt
to prevent hypoglycemia and a rapid drop in sugar because it can result in cerebral edema
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pt with dka wil present with __ BP and __HR
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what type of iv would you start with DKA pt
large bore needle(18g)
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emergency correction of dehydration rate
ns 500-1000 ml/hr for first 2 hrs
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with correction of electrolytes what are you replacing
- water
- sodium
- chloride
- HCO3
- potassium
- PO4(phosphate)
- mg
- nitrogen
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how are we correcting acidosis
- iv insulin at 0.1U/kg/hr
- asses insulin every hr
- sodium bicarb if ph is less than 7
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HHS age onset
over 60 with type 2 diab
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what causes HHS
there is just enough circulating insulin to prevent DKA but not enough to prevent hyperglycemia, osmotic dieurisis and ECF depletion
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HHS s/s
- neuro
- absence of ketoacidosis
- profound dehydration
- loss of electrolyte
- -impaired thirst sensation
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HHS patho
- hyper
- osmostic dieurisis
- fluid volume deficit
- decrease sodium, potassium and phosphorus
- electrolyte imbalance
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HHS lab values
- gluecose over 600
- serum osmolality increase
- ketones absent
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HHS treatment
similar to dka except greater fluid replacement
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chronic complications of diabetes
- angiopathy(macro/micro vascular)
- retinopathy
- neuopathy
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macrovascular patho
- -great freq and earlier onset diabetes
- -promoted by altered lipid metabolism
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-
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MacroV
CVA(stroke)
- -arthrosclerosis of cerebral vessels
- -htn
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microV defined
thickening of vessle membranes in capillaries and arterioles in response to chronic hyperglycemia
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two types of diabetic retinopathy
nonprolif and prolif
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nonproliferative retionpathy
- -most common
- -partial occlusion
- -mycroaneurysms in cap walls
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proliferative retionpathy
- -when retinal caps are occludeed
- -body forms new vessles
- -retinal detatchment
- -vessles are fragil
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retinopathy Tx
- laser photo
- iluvien
- blocking VEFG
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vitrecotomy
aspiration of blood, membrane, fibers from inside eye through small incision
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