Pathophysiology & Risk Factors
What is the underlying cause of Type II diabetes?
Insulin resistance — cells stop responding effectively to insulin, forcing the pancreas to produce more until β-cell fatigue develops.
What is the first-line oral agent for Type II DM and its main mechanism?
Metformin (Biguanide) — decreases hepatic glucose production and increases insulin sensitivity.
What blood glucose and serum osmolality levels are diagnostic for HHNS?
BG ≥600 mg/dL and serum osmolality ≥340 mOsm/L.
What is the initial priority in managing HHNS?
Aggressive IV fluid resuscitation with 0.9% NS to correct dehydration and restore perfusion.
What type of exercise is best for improving insulin sensitivity?
Aerobic exercise (e.g., brisk walking, swimming) — enhances glucose uptake by muscles.
What are three modifiable risk factors for developing Type II diabetes?
Obesity (BMI >25), sedentary lifestyle, and poor diet high in refined carbs and fats.
Which drug class should be avoided in patients with chronic heart failure due to fluid retention?
Thiazolidinediones (TZDs) such as pioglitazone and rosiglitazone.
Why are ketones usually absent in HHNS?
There is enough circulating insulin to prevent fat breakdown and ketone formation.
When should the nurse add dextrose to IV fluids during HHNS management?
When BG drops to 250–300 mg/dL, to prevent rebound hypoglycemia and cerebral edema.
What dietary advice helps prevent blood glucose spikes in Type II DM?
Eat complex carbs with fiber, balance meals with lean protein and healthy fats, and avoid sugary drinks.
Which ethnic groups are at higher risk for Type II DM?
African American, Hispanic/Latino, Native American, Asian American, and Pacific Islander populations.
Which drug class delays carbohydrate absorption in the intestine and may cause GI discomfort?
Alpha-glucosidase inhibitors (e.g., acarbose, miglitol).
Which clinical finding best distinguishes HHNS from DKA?
Gradual onset with profound dehydration and neurological changes, but normal acid-base balance.
Why should insulin therapy in HHNS be titrated slowly?
Rapid correction of hyperglycemia can cause cerebral edema due to osmotic fluid shifts.
How should patients self-monitor blood glucose when starting new medication or exercise regimens?
Check BG before meals and at bedtime and increase frequency when routines or stress levels change.
Why can chronic hyperinsulinemia lead to weight gain and further insulin resistance?
Excess insulin promotes fat storage and suppresses lipolysis, worsening metabolic imbalance.
Which medication class helps promote glucose excretion through the urine and increases the risk for genital yeast infections?
SGLT-2 inhibitors (e.g., empagliflozin, dapagliflozin).
What is the most common precipitating factor for HHNS in older adults?
Infection or illness that increases insulin demand and causes dehydration.
What key labs should the nurse monitor during HHNS management?
BG, serum sodium, potassium, BUN/creatinine, and serum osmolality.
Why is annual kidney and eye screening essential for Type II diabetics?
To detect nephropathy and retinopathy early, since chronic hyperglycemia damages small vessels.
How does metabolic syndrome increase the risk of Type II DM and cardiovascular disease?
It combines abdominal obesity, hypertension, dyslipidemia, and insulin resistance, leading to vascular inflammation and glucose intolerance.
Which oral agent mimics incretin hormones to enhance insulin secretion and suppress glucagon release, and what is its benefit?
GLP-1 receptor agonists (e.g., liraglutide, semaglutide) — they promote weight loss and reduce cardiovascular risk.
Why might HHNS patients present with seizures or coma?
Extreme hyperosmolality causes cellular dehydration in brain tissue, leading to neurological dysfunction.
What complication can occur if potassium is not replaced during HHNS treatment?
Cardiac dysrhythmias due to hypokalemia from insulin shifting K⁺ intracellularly.
What should be included in teaching about preventing HHNS recurrence?
Maintain hydration, monitor BG more often during illness, continue medications, and seek help if confusion, dry mucous membranes, or very high readings occur.