What is the cause of ketoacidosis and what population does it affect most?
- profound deficiency of insulin
- type 1 diabetics
What physiologic problems does ketoacidosis cause?
- Glucagon excess
- Diabetic coma
Signs and symptoms of Ketoacidosis
- poor skin turgor
- dry mucous membranes
- Orthostatic hypotension
- Abdominal pain
Treatment of ketoacidosis
- Correct fluid/electrolyte imbalance: IV infusion 0.45% or 0.9% NaCl
- Potassium replacement
- Sodium bicarbonate
Laboratory findings of Ketoacidosis
- blood glucose level greater than or equal to 250 mg/dL
- arterial blood pH less than 7.30
- serum bicarbonate level less than 16 mEq/L
- moderate to large ketones in the urine or serum.
What population does Hyperosmolar hyperglycemic syndrome (HHS) often occur in?
patients older than 60 years with type 2
Laboratory findings of HHS
- blood glucose level greater than 600 mg/dL
- increase in serum osmolality
- Ketone bodies are absent or minimal in both blood and urine
Treatment of HHS
IV administration of insulin and either 0.9% or 0.45% NaCl
What does Diabetic foot care include?
- Annual screening using a monofilament
- Proper footwear
- Avoid injury to the foot
- Practice diligent skin and nail care
- Inspect the foot thoroughly each day
- Treat small problems promptly
What is autonomic neuropathy?
can affect nearly all body systems and lead to hypoglycemia unawareness, bowel incontinence and diarrhea, and urinary retention.
What is Sensory Neuropathy?
- loss of sensation, abnormal sensations, pain, and paresthesias
- affects the hands and/or feet bilaterally
- Complete or partial loss of sensitivity to touch and temperature is common
What is diabetic nephropathy?
a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney
What is the treatment for a pt with hypoglycemia who is unconscious or symptoms are worstening?
- SubQ or IM injection of 1mg glucagon
- IV administration of 25-50mL of 50% glucose
What is the treatment for a pt with hypoglycemia who is conscious?
- 15 to 20gm of fast acting glucose Q15min x3
- short acting with long acting (carbohydrates with fat or protein) if next meal is longer than 1hr away
What is the symogyi phenomena and how do you treat it?
hyperglycemia in the morning treated with decreased insulin at night
What is dawn effect and how do you treat it?
hyperglycemia upon wakening treated with increased insulin before bed
What is included in sick day management?
- more frequent blood glucose checks (Q4hr)
- stress management
- increased fluids
- report to physicians if more than 2-3 readings in a row are high
- check for ketones
- intraoperative management- IV fluids and insulin
Ideally, the goal of patient diabetes education is to:
A. Enable the patient to become the most active participant in the management of the diabetes.
Sulfonylureas: Mechanism of action and complications
- Stimulate release of insulin from pancreatic islets
- Weight gain, hypoglycemia, diarrhea, infection, anaphylaxis
Thiazolidendinedones: Mechanism of action and complications
- Increase glucose uptake in muscle
- Weight gain, edema, increase risk for bladder cancer and exacerbate heart failure, increase risk for cardiovascular events increase fracture risk
Metformin: Mechanism of action and complications
- Decreases rate of hepatic glucose production
- Diarrhea, lactic acidosis. Must be held 1-2 days before IV contrast media given and for 48 hr after.