Type 1 DM
What are common presenting symptoms for a type 1 diabetic?
3 P's- polyuria, polyphagia, polydipsia
The difference between Type 1 and Type 2 diabetics is that type 2 diabetics _________.
Still produce insulin but have reduced insulin sensitivity or decreased insulin production.
2 medications, situations, or therapies that may require additional insulin to be administered to a diabetic patient.
Steroids, Phenytoin (Dilantin), TPN, stressful event (surgery), overconsumption of carbohydrates, DKA.
Name two lab tests that may indicate nephropathy in a diabetic patient.
Elevated creatinine, albuminurea, elevated BUN
Deep, rapid breathing that occurs with DKA
Kussmaul respirations
5 symptoms of a patient with hypoglycemia
Agitation, 'hangry', tachycardic, diaphoretic, headache, shakiness, fatigue, tremors, confusion, loss of coordination, unsteady gait.
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.
Lab indicators:
What is a normal fasting glucose level?
What test is a 3 month indicator of glucose control?
What is the target range of blood glucose?
<100, HgbA1C (< 6.5) and 70-120
Give two 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
Confusion, Disorientation, Thirst, Weight loss, tachycardic, hypotension, kussmaul respirations, fruity breath, abdominal pain
Explain the pathophysiology of Type 1 DM
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?
Do not take insulin/oral anti-diabetic agents the day of surgery. 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?
Maintain control of blood glucose!
What pH would you expect a patient with DKA have?
Less than 7.35
The Type 1 patient is at home ill with a viral infection. What 3 pieces of nursing education might the clinic nurse provide?
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 patient with type 2 diabetes comes to the clinic with an A1C reading of 8.4. What lifestyle modification/education is needed? Name 3 items.
Aerobic exercise 150 min/week, Goal for blood glucose 70-120, Consistent carb intake, low glycemic foods, eat consistent foods, check blood glucose as recommended by MD
How might a patient describe neuropathy?
Tingling, burning, shooting pain
What are two priority interventions for a patient in DKA?
Safety, glucose management, hydration with IVF, 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
Name 4 situations when a diabetic patient might need to check their glucose levels.
Prior to administering insulin, prior to meals, if they feel 'low'- hypoglycemic, if they feel 'high'- hyperglycemic, before exercising, before bed
What teaching should be provided to a patient with 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.
Name 4 types of complications resulting from uncontrolled diabetes
Microvascular issues, macrovascular issues, nephropathy, neuropathy, retinopathy, wound healing complications
What may be a precipitating cause of DKA
Missing insulin doses, stress, illness