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What is the cause of ketoacidosis and what population does it affect most?
- profound deficiency of insulin
- type 1 diabetics
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What physiologic problems does ketoacidosis cause?
- Glucagon excess
- Hyperglycemia
- Polyuria
- Polydipsia
- Polyphagia
- Diabetic coma
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Signs and symptoms of Ketoacidosis
- Lethargy
- Dehydration
- poor skin turgor
- dry mucous membranes
- Tachycardia
- Orthostatic hypotension
- Abdominal pain
- Kussmaulrespirations
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Treatment of ketoacidosis
- Correct fluid/electrolyte imbalance: IV infusion 0.45% or 0.9% NaCl
- Potassium replacement
- Sodium bicarbonate
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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.
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What population does Hyperosmolar hyperglycemic syndrome (HHS) often occur in?
patients older than 60 years with type 2
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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
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Treatment of HHS
IV administration of insulin and either 0.9% or 0.45% NaCl
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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
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What is autonomic neuropathy?
can affect nearly all body systems and lead to hypoglycemia unawareness, bowel incontinence and diarrhea, and urinary retention.
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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
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What is diabetic nephropathy?
a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney
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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
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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
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What is the symogyi phenomena and how do you treat it?
hyperglycemia in the morning treated with decreased insulin at night
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What is dawn effect and how do you treat it?
hyperglycemia upon wakening treated with increased insulin before bed
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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
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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.
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Sulfonylureas: Mechanism of action and complications
- Stimulate release of insulin from pancreatic islets
- Weight gain, hypoglycemia, diarrhea, infection, anaphylaxis
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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
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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.
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