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/conditions/therapies that may require additional insulin be administered
Steroids, stressful events (surgery), enteral/parental feedings.
What are the reasons a client would have an elevated BG in the morning even after taking their insulin as prescribed?
Dawn Phenomenon, Somogyi effect, and Insulin Waning.
These type of fluids are utilized to rehydrate a patient in DKA. Name 1 type of IVF.
Initially an isotonic solution, then change to hypotonic when BG <300mg/dl (0.45% saline)
What is the major difference between DKA and HHS?
onset/ketones in the urine/BG levels
DKA (Rapid onset) HHS (slow onset)
DKA BG >250 HHS >600
5 symptoms of a client with hypoglycemia
Agitation, 'hangry', tachycardic, diaphoretic, headache, shakiness, fatigue.
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.
Normal fasting glucose level, 3-month indicator of glucose control, and targeted glucose range
<100, HgbA1C (< 6.5) and 70-100
3 education points for the client with neuropathy
Inspect feet daily, wear flat shoes, do not use heating pads, no lotion between toes, cut nails straight across, etc.
Name 3 symptoms of a client in DKA
Confusion, Disorientation, Thirst, Weight loss, tachycardia, hypotensive, Kussmaul's respirations
Diagnostic tests for HHS
BG >600, serum osmolality >350, CBC, ABG, BUN, electrolytes
Autoimmune illness, body attacks beta cells within pancreas resulting in altered function of pancreas--> unable to produce insulin
A Type 2 DM client is preparing for surgery. What education will be needed?
Maintain NPO status. The client may have to stop taking oral antidiabetic/insulin medication per provider (Type 2 diabetic), check BG more frequently, Type 1 DM need their insulin
What are 4 diagnostic tests used to screen for DM?
A1C, glucose tolerance test, fasting blood sugar, and random BG.
What is the best way to prevent diabetes associated complications
Meticulous blood glucose control!
What are 3 laboratory findings that are seen in clients with DKA?
300 and 800 mg/dL or higher, low pH, low bicarbonate or HCO3, increased BUN and creatinine (dehydration), NA or K+ low or high depending on water lost. Ketones in urine or bloodstream
Name three common causes of HHS
Infection, medications (thiazide-diuretics for BP management), and dialysis
What are 3 teaching points the nurse would include for a type 1 DM client who has a viral illness?
Check BG every 3-4 hours, consume fluids, administer ordered insulin, avoid strenuous exercise, monitor for s/s of DKA
The client's blood glucose level is 68 and they feel lightheaded. What intervention would you provide?
Give juice (apple) or 15g carb 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 the cause of hypoglycemia.
A client with Type 2 DM has Glycosylated hemoglobin (A1C) of 8.4%. What lifestyle modification/education is needed? Name 4 items.
Aerobic exercise 150 min/week, Goal for blood glucose 70-100, low glycemic foods, eat consistently from each food group 50-60% carbs, 20-30% fat, increase fiber, check blood glucose as recommended by MD
How might a client describe neuropathy? What medications would help to treat this condition?
(Extra 100 pts)
Tingling, burning, shooting pain,
Extra 100 points if medication is known. Gabapentin (Neurontin), Pregabalin (Lyrica)
What is a priority intervention for a patient in DKA?
Safety, glucose management, hydration with IVF, , potassium management, and hourly BG checks
What is the priority intervention for a client with HHS?
Fluid replacement
A diabetic client has the following presentation: unresponsive to voice or touch, tachycardia, and diaphoretic. What are 2 priority actions for the nurse to implement?
Check BG and administer 50% dextrose IV per protocol
When might a client need to check their glucose levels- name 4 occasions
Prior to administering insulin, prior to meals, if they feel 'low'- hypoglycemic, if they feel 'high'- hyperglycemic, before exercising, before bed
Client teaching for the 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 4 P's, Sick day plan from an endocrinologist
Name 4 types of complications resulting from uncontrolled diabetes
Angiopathy, nephropathy, neuropathy, retinopathy, wound healing complications
What may be a precipitating cause of DKA
Missing insulin doses, stress, illness
What is a common complication with the treatment of HHS?
Fluid overload