Signs and Symptoms
Confusion, blurry/double vision, drowsiness, emotional changes, HA, impaired coordination, inability to concentrate, irritability, light headedness, numbness of the lips and tongue, slurred speech
What is moderate hypoglycemia?
The most common Autoantibody Panel used to test for type 1 or Risk of developing type 1 DM.
What is Glutamic acid decarboxylase autoantibodies (GADA)?
Type of diabetes that requires insulin administration.
What is type I?
•T1DM occurs when pancreatic beta cell destruction which produce insulin in the islets of Langerhans leading to absolute insulin deficiency. Risk factors include genetic predisposition, viruses (immunologic), medications, and trauma. Signs and symptoms include polydipsia, polyuria, polyphagia, fatigue, and weight loss.
A progressive deterioration of nerve function that results in loss of sensory perception. People with diabetes may describe numbness, tingling, or pain at the extremities.
What is Peripheral Neuropathy ?
A microvascual complication.
Teach the client manifestations of hyperglycemia.
What is hot, dry skin, and fruity breath?
Teach glucose monitoring
•Waist circumference greater than 35 for women, 40 for men (abdominal obesity)
•Blood glucose level greater than 100 or on a diabetes medication (hyperglycemia)
•Blood pressure greater than 130/85 (hypertension)
•Triglyceride level greater than 250
•HDL less than 40 for men, 50 for women
What is Features of Metabolic Syndrome?
Characterized by HTN, hypercholesterolemia, and ABD obesity.
A test that measures glucose control over 3 months.
What is Hemoglobin A1c or glycosylated hemoglobin?
Hemoglobin A1c or glycosylated hemoglobin is a test that measures how much glucose permanently attaches to hemoglobin molecules. It is used for diagnosis and to assess effectiveness of diabetes management. Hemoglobin molecules live 3 months in the body.
An A1c is measured using a 3 month-old red blood cell. This is why some people with diabetes refer to an A1c as a “three month” test.
The A1c goal for someone with diabetes is 7.0 mg/dl (6.5%-8% range). The higher the A1c level, the stickier the cells.
Treatment of mild, moderate, and severe hypoglycemia.
What is
•Mild – Give 10-15 g simple carbohydrate, repeat if necessary (fruit juice, glucose gel)
•Moderate - 15-30 g simple carbohydrate, repeat if necessary
•Severe - 1 mg glucagon IM or SC, 2nd dose in 10 min, or if in hospital 25 ml D50W IV Repeat
Rule of 15!
Diabetes is the leading cause of ______________ in the US.
What is kidney failure/ESRD?
Nephropathy is a pathological change in the kidney that reduces kidney function and leads to kidney failure. Diabetes is the leading cause of kidney failure in the United States. Chronic high glucoses cause hypertension in the kidneys (think thick blood) and excess perfusion. The blood vessels begin to leak and protein deposits on narrow blood vessels leading to kidney cell hypoxia and cell death. Hypertension increases the progression of diabetic nephropathy.
The benefits of an insulin pump.
What is consistent blood glucose control by mimicking the body natural response?
Fast and deep breathing
What is Kussmaul respirations associated with DKA?
Results indicating diabetes:
A1c greater than ____%
Fasting blood glucose > ____, TWICE (8hr)
Random blood glucose > ______, AND ..... what s/s?
2-hour plasma glucose > ____, during OGTT
(using 75g load)
A1c greater than 6.5%
•Fasting blood glucose > 126, TWICE (8hr)
What is ...?
•Random blood glucose > 200, AND
classic s/s of hyperglycemia (polyuria, polydipsia
unexplained weight loss) or hyperglycemic crisis
•2-hour plasma glucose >200, during OGTT
(using 75g load)
Prediabetes is indicated with A1c 5.7-6.4%.
First line treatment for type 2 DM.
What is diet, activity, stress management, diabetes education, and medications such as metformin are initially used to treat T2DM ?
Three macrovascular complications of diabetes.
What is stroke, MI, PAD?
Sticky cells and thick blood cause blockages or clots leading to myocardial infarction, stroke, and/or peripheral artery disease.
Diabetic foot care.
What is
•Inspect daily
•Shoes – fit well, no rubbing, wear clean socks
•Care – wash and dry, keep soft, moisturize
•Water temperature – warm
•Awareness of chances for injury (heating pads, walking barefoot)
•Seek medical attention quickly
•Exercise
•Trim nails carefully, separate overlapping toes
PH 7.1, fruity breath, BG 550, ketones in urine
What is DKA?
Indications for screening for diabetes.
What is ...
•Greater than 45 years old
•BMI greater than 25 AND one of the following
first degree relative with diabetes
high risk population
gave birth to baby weighing more than 9 pounds
hypertension
HDL less then 35 or triglyceride level greater than 250
PCOS – Polycystic ovarian syndrome or GDM
A1c greater than 5.7% on previous testing
vascular disease
At age 45, if glucose/A1c values are within range, testing should occur every 3 years.
Goals and treatment for DKA.
What is
•Fluid resuscitation and insulin therapy (IV Regular Insulin)
•The client usually receives 0.9% normal saline until glucose is less than 250. Once glucose levels are less than 250, the client receives 5% dextrose in 45% normal saline (D5 1/2NS). It is recommended the client remain NPO and on continuous insulin until glucose levels are less than 250, anion gap is less than 12, and pH is greater than 7.0. Glucose will need to be checked hourly. As treatment continues, fluid resuscitation occurs and electrolyte levels will decrease, often too much. Electrolytes, especially potassium should be monitored frequently. Hypokalemia is a frequent cause of death in those with DKA. To prevent hypokalemia, potassium replacement is initiated after serum levels fall below 5.0 mEq/L
•When administering fluid boluses, monitor cardiac and kidney function
When administering insulin and altering electrolytes quickly, monitor for cerebral edema. Treatment should be slow and steady. Also, monitor body weight, urine output, kidney function, pulmonary congestion, blood pressure, central venous pressure and wedge pressure
__________ is reduced due to a decrease in white blood cell activity.
What is Immunity?
Infections !!! - Yeast infections and urinary tract infections are more common in people with diabetes. Wounds/Skin Infections-poor healing
Sick day rules.
What is
•Monitor glucose more often. Test urine for ketones (Q4)
•Test for ketones when glucose is greater than 240 mg/dl.
•Continue to take medications unless instructed by provider.
•Drink 8 to 12 ounces of sugar-free/noncaffinated fluids every hour while awake. If glucose is low, drink sugar beverage.
•Call the doctor if unable to tolerate solid foods.
•Call your doctor if persistent nausea and vomiting, moderate or high ketones, and if temperature greater than 101.5.
•Get plenty of rest.
BG 850, no ketones in urine, dehydration
What is Hyperglycemic- Hyperosmolar State (HHS)?
Ranges of mild, moderate, severe hypoglycemia.
What is
•Mild (BG < 70) - Client remains alert, able to self manage
•Moderate (BG < 40) – Needs assistance but can follow directions
•Severe (BG < 20) - Unconscious, another person is needed to manage symptoms
Always check glucose before treating it!!!!!!!
Goals and interventions for HHS.
What is ...
•Fluid resuscitation (half NS is used unless hypotension is present; NS would be used to increase blood volume)
•Goal = rehydrate the patient and restore normal blood glucose levels within 36 to 72 hours. (SLOWLY) ! Half of the fluid lost should be replaced within 12 hours and the rest is given over the next 36 hours
•The goal is for glucose to decrease by 50-70mg/dl per hour to reach goal. Continue to monitor electrolytes, especially potassium.
Results from lack of sufficient insulin. Commonly with undiagnosed or untreated type 1 diabetes mellitus or noncompliance. Infection is the most common cause due to the increased insulin need.
What is DKA?
Activity considerations.
What is
Clients with diabetes should monitor glucose prior to, during, and after activity.
If glucose is less than 100, they should eat carbohydrate foods and recheck glucose prior to exercise. Carbohydrates should be consumed throughout activity. Exercise can cause hypoglycemia.
Fun fact: 20 minutes of moderate activity lowers glucose levels 15-20mg/dl
If glucose is greater than 200, they should test for ketones. If ketones are present, current insulin levels aren’t high enough to prevent hyperglycemia with exercise and the client should not exercise.
In the absence of contraindications, clients with diabetes should be encouraged to perform at least 150 minutes of activity per week. This could be divided over 3 days. Teach patients to avoid going more than 2 consecutive days without aerobic activity and to perform resistance exercise at least twice weekly.