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.
2 Medications/conditions/therapies that may require additional insulin be administered
Steroids, Phenytoin (Dilantin), TPN, stressful event (surgery)
What labs would indicate nephropathy?
Elevated creatinine, albuminurea, elevated BUN
What is hypotonic fluids (drive fluid into cell), .45 NS
5 symptoms of a patient with hypoglycemia
Cold, clammy skin, hunger, tachycardic, faintness, dizziness, headache, shakiness.
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, a 3-month indicator of glucose control, and targeted glucose range
<100, HgbA1C (< 6.5) and 70-110
3 education points for the patient with neuropathy
Inspect feet daily, wear flat shoes, no lotion between toes, cut nails straight across, etc.
Name 3 symptoms of a patient in DKA
Dry mucous membranes, Kussmaul respiration with fruity breath to reverse metabolic acidosis, a glucose level of 250 mg/dL or greater, pH<7.3, bicarb <16, ketonuria
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?
Take insulin/oral anti-diabetic agents on the day of surgery if ordered. 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
Patient's blood glucose level is 68 and they feel lightheaded. What intervention would you provide?
Give 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? Name 4 items.
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)
What is a priority intervention for a patient in DKA?
IV fluid administration, IV administration of short-acting insulin, Electrolyte replacement, hourly BG checks
A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, and diaphoresis. What is a priority action?
Check BG and administer 50% dextrose IV per protocol
When might a patient need to check their glucose levels- name 4 incidences
Prior to administering insulin, prior to meals, if they feel 'low'- hypoglycemic, if they feel 'high'- hyperglycemic, before exercising, before bed
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 4 types of complications resulting from uncontrolled diabetes
Angiopathy, nephropathy, neuropathy, retinopathy, wound healing complications
What may be a precipitating cause of DKA
Missing insulin doses, infection, illness, undiagnosed type 1 DM; lack of education, understanding, or resources; and neglect