Type 1 DM
What are common presenting symptoms for a type 1 diabetic?
3 P's- polyuria, polyphagia, polydipsia
Still produce insulin but have reduced insulin sensitivity or decreased insulin production.
Decreases because exercise helps improve insulin sensitivity
What happens with insulin requirements for a diabetic patient when they exercise?
This medicine should be stopped before an IV contrast procedure.
What is Metformin?
These types of fluids are utilized to rehydrate a patient in DKA. Name 1 type of IVF.
What are hypotonic fluids (drive fluid into cell), 0.45% NS
Some symptoms of a patient with hypoglycemia
Agitation, 'hangry', tachycardic, diaphoretic, headache, shakiness, fatigue, palpitations.
You are caring for a type 2 DM patient who states they feel lightheaded. They last ate 3 hours ago. What intervention is most appropriate?
Check BG via fingerstick, pt could be hypoglycemic.
Normal fasting glucose level, 3 month indicator of glucose control, and targeted glucose range
<100, HgbA1C (< 6.5) and 80-110
Education points for the diabetic patient
What are inspecting feet daily, wearing flat shoes, no lotion between toes (Legs & feet ok), cutting toenails straight across, etc.?
Name some symptoms of a patient in DKA
Dry, hot skin, fruity breath, deep respirations (kussmaul), abdominal pain, confusion, disorientation, thirst, tachycardic, hypotensive, etc.
Autoimmune illness, body attacks beta cells within pancreas resulting in altered function of pancreas--> unable to produce insulin
A Type 2 DM patient is preparing for surgery. What education will be needed?
Do not take insulin/oral anti-diabetic agents the day of surgery. Maintain NPO status.
Why are mixed drinks not encouraged for a diabetic patient?
These drinks can contain large amounts of glucose, elevating the patient's glucose with subsequent drops in BG. It is preferred to drink a lighter drink, with food.
What is the best way to prevent diabetes associated complications
Meticulous blood glucose control!
What ABG findings would a patient with DKA have?
Metabolic acidosis, low pH 7.2, low HCo3 <16, generally low CO2 follows as the respiratory system tries to buffer acidosis in the body
Check BG every 2-4 hours, consume fluids without added sugar, administer ordered insulin, avoid strenuous exercise, monitor for s/s of DKA
The patient's blood glucose level is 68, and they feel lightheaded, anxious, and shakey. What intervention would you provide?
Give 4 to 6 oz of juice (orange or apple) and recheck glucose in 15 minutes. If not elevated in 15 min, repeat juice and recheck in 15 min. Once elevated, give complex carb (milk/graham cracker) and evaluate cause of hypoglycemia.
A Type 2 patient comes to the clinic with an A1C reading of 8.4. What lifestyle modification/education is needed?
Aerobic exercise 150 min/week, Goal for blood glucose 80-110, Consistent carb diet, low glycemic foods, eat consistent foods, check blood glucose as recommended by MD
How might a patient describe neuropathy? What medications would help to treat this condition?
Tingling, burning, shooting pain, Gabapentin (Neurontin), Pregabalin (Lyrica)
Never
When should a Type 1 DM hold their insulin?
Shows that the patient's diabetes is well-controlled
What is a drop in HbA1c level from 10.8% to 7.5%?
Pt teaching for the type 1 DM to prevent DKA from occurring?
Check BG every 2-4 hours when ill, do not skip insulin doses when ill, check urine for ketones when ill, monitor for 3 P's, Sick day plan from endocrinologist
Name a complication resulting from uncontrolled diabetes
nephropathy, neuropathy, retinopathy, wound healing complications
What may be a precipitating cause of DKA
Missing insulin doses, stress, illness