Diabetes

Assessment

100

Clinical manifestations, affected body systems

Type I

o Insulin cells are destroyed

o Glucose in bloodstream, glucose in urine, ketone bodies increase

 Type II

o Beta cells can’t keep up with insulin demand

o Onset is progressive: mild symptoms initially

Treatment

100

Diet

50-60% carbs

 20-30% protein

 10-20% fats

 1 unit of insulin= 15g carbs

 Must distribute calories amongst meals: carb budget of 45-60g per meal

 Exchange list

o Bread, veggies, milk, fruit, fats

o Can pick and choose from categories

200

Alcohol

Should drink alcohol with a meal or immediately before to help prevent

alcohol induced hypoglycemia

 Wear a medical alert bracelet

300

Insulin

Rapid (used for DKA)

 Short: used before meals

 Intermediate: used at nighttime

 Short and intermediate are usually used together

Nursing Care

100

Survival skills

Pathophysiology

 Treatment modalities

 Recognition, treatment, and prevention of hypo/hyperglycemia

 Pragmatic info: where to buy and storer insulin, when to contact PCP

200

Sick day rules

Stick to same medication routine

 Increase testing for glucose and urine ketones every 3-4hours

 Drink fluids with sugar every 30-60min for calories and to prevent dehydration

 If unable to retain fluids seek medical attention

Complications

100

Hypoglycemia: clinical manifestations; treatment at home and in hospital

Clinical manifestations

o Shaky

o Tachycardia

o Sweaty

o Dizzy

o Anxious

o Hungry

o Weak

o Blurred vision

 Treatment

o Treat with concentrated carbs

o Always carry a fast-acting form of sugar

200

DKA

Lack of insulin causes increased fat breakdown which increases ketone bodies making the blood more acidic

 Causes:

o Sepsis

o Sickness

o Stress

o Skip insulin

 Clinical manifestations

o Rapid onset: less than 24 hours

o Early s/s: frequent urination, thirst or dry mouth, high blood glucose, high ketones

o Late s/s: tired, n/v, dry skin, fruity breath, hard time breathing, confusion

o Blood glucose: 200-500+

 Treatment

o Rehydration

 Start with normal saline

 When under 300 bg change to D5W (want to bring

down sugar slowly)

o Hourly blood glucose checks

300

HHS

Persistent hyperglycemia causes loss of water and electrolytes

 Clinical manifestations

o Slower onset of several days to weeks

o Signs of dehydration and neurological issues

 Assessment

o Blood glucose 600-1200

 Treatment

o Monitor volume and electrolytes

o Replace fluid loss slowly

o Insulin replacement therapy

o Correct underlying cause

o Prevent complications

 Fluid overload, pulmonary edema, heart failure,

hypokalemia, hypoglycemia, cerebral edema