Hypoglycemia
What is the definition of hypoglycemia?
When the BG falls below 70 mg/dl---occurs when there is too much insulin or too much oral antidiabetic agents, too little food, excessive physical activity
What are some signs that indicate a patient's BG is high?
polyphagia, polydipsia, polyuria
True or False--Type I DM results in destruction of the pancreatic beta cells, resulting in severely decreased to no insulin production by the pancreas
True
What are the two main problems related to Type II DM?
insulin resistance---inability of tissues to take in insulin effectively
impaired insulin secretion--beta cells not secreting enough insulin (they do secrete enough though to keep your body from producing ketones)
True or False--Metformin is used in the hospital setting in patients who are expected to go for testing/surgery
False---these patients are transitioned to insulin because of the nephrotoxic effects of metformin used with contrast
What is mild hypoglycemia?
Where the sympathetic nervous system is stimulated, resulting in a surge of epi and norepi. Symptoms are sweating, tremors, tachycardia, palpitations, nervousness and hunger
What does it mean if someone has hyperglycemia between 5 and 6 AM, with normal BG at bedtime?
Dawn Phenomenon---p 1503
True or False---DKA results from ketone production in Type I DM
True
What is the basic criterion for both Type I and Type II DM
An abnormally high blood glucose level---p 1492
Take a look at chart 46-2 on p 1492
What medication MUST be used in the patient with Type I DM?
insulin
What is moderate hypoglycemia?
Where BG falls to where your brain cannot process anything due to "lack of fuel". Symptoms are inability to concentrate, headache, lightheadedness, confusion, irrational behavior
What are big teaching points in the patients who have Diabetes related to foot care?
trim toenails straight across, utilize podiatrist if necessary to do this
wash feet daily
dry between toes
inspect feet daily
p 1527--chart 46-11
True or False--Diabetes Type I is often associated with an autoimmune cause
True---small cases are reported to be "idiopathic", but most are of autoimmune cause
What is the main goal of DM treatment (for both Type I and II)
to normalize insulin activity and blood glucose levels to reduce the development of complications
What is a short-acting insulin?
regular insulin (clear; given 15 min before a meal)
What is severe hypoglycemia?
where the patient cannot perform functions independently. They are very disoriented, have seizures, difficulty with arousing, or loss of consciousness
What is the best therapeutic response to patients who express frustrations with DM?
Use open-ended questions---"tell me more" "can you explain"
When is someone often diagnosed with Type I DM?
childhood---less than 30 years of age per p 1488 in Hinkle
What are some ways to look at meal planning?
exchange lists, nutrition labels with carb counting, healthy food choices, MyPlate food guide, use of glycemic index
what is a rapid acting insulin?
lispro/aspart---must eat within 5-15 minutes of admin
What is the recommended treatment of hypoglycemia for the patient who is conscious and can take in orally?
15-20g of a fast acting carb, such as juice
What would be examples of "sick day rules"
chart 46-9 on p 1514.
take insulin or oral antidiabetics as usual
test blood glucose and urine ketones every 3-4 hours (ketones if Type I)--report abnormal levels to HCP
report nausea/vomiting/diarrhea to your HCP---extreme fluid loss is dangerous for these patients
If unable to retain oral fluids, patient may need to be hospitalized
Is Type I DM inherited?
No---people may have a genetic predisposition though
What are some general considerations for exercise in the patient with DM?
p 1497 chart 46-4
exercise 3x weekly with no more than 2 days consecutively without exercise
use proper footwear
avoid exercise in extreme heat or cold
exercise at the same time of day and for the same duration (preferably when BG is at its peak)
What is one big thing that you should know how to do from reading the book/learning in lab?
insulin administration!
can you mix insulins? you can mix all insulins except for your lantus, or basal, insulin. Remember clear, before cloudy! I remember it as "RN" regular or rapid then NPH.