DKA
Defining characteristics of DKA?
BG >300, more common in DM Type 1, break down fats for energy which releases ketones into the urine
Defining characteristics of HHS?
Extreme hyperglycemia (300-400) and insulin resistance usually in type 2 diabetics. No ketosis or acidosis bc there is just enough insulin to avoid fat metabolism.
Define gestational diabetes
any degree of glucose intolerance and carbohydrate intolerance that has its first onset during pregnancy
What is the pathophysiological difference between type 1 and type 2 diabetes?
Type 1 cause is unknown and characterized by a lack of insulin production. Type 2 is characterized by insulin resistance.
S/S of hypoglycemia?
reduced cognition, tremors, diaphoresis, weakness, hunger, headache, irritability, BG<70
Symptoms of DKA?
polyphagia, polydipsia, polyuria, ketonuria, fruity breath, kussmaul breathing, dehydration, n/v, belly pain, tachycardia, hypotension, confusion, fatigue, BG >300
S/S of of HHS
BG >400, polyphagia, polydypsia, polyuria, severe dehydration, febrile, fatigue
What effects does GDM have on the mother during pregnancy?
at risk for preeclampsia, UTIs, polyhydramnios due to fetal diuresis, ketoacidosis, macrosomia
Risk factors for DM Type 1?
Age, family history, race
Risk factors for Type 2 diabetes?
age, family history, race, lifestyle (diet, exercise, weight), medications
Causes of DKA?
infection, use of steroids or thiazide diuretics, not taking insulin, not eating regular meals, undiagnosed DM
Causes of HHS
infection, elderly, gradual onset
What effects does GDM have on the fetus during pregnancy?
at risk for congenital malformation, variations in fetal size (macrosomia), birth trauma
S/S of hyperglycemia?
polyuria, polydipsia, dehydration, fatigue, fruity odor to breath, kussmaul breathing, wt loss, hunger, poor wound healing, polyphagia, BG >140
What are some chronic complications of DM?
microvascular disease, neuropathy, blindness, sexual dysfunction, cognitive dysfunction, heart disease, stroke, kidney failure, loss of limbs
Nursing Interventions for DKA
educate on monitoring and prevention - esp when ill, hydration and glucose control (insulin), IV NS, IV Regular Insulin, regular BG checks
Interventions for HHS
IV fluids (isotonic or hypotonic), insulin bolus and drip (regular only), montor for s/s of hypokalemia, administer potassium supplements as needed/ordered
Which pregnant women are screened for gestational diabetes? How are they screened?
ALL pregnant women are screened as part of routine prenatal care; the glucose challenge test is peformed between 24 and 28 weeks gestation, the pt ingests 50gm of glucose at one time and has bg tested 1 hour later
insulin is produced by islets of Langerhans in beta cells of pancreas; lowers glucose by moving it out of the bloodstream into the cells for energy
What is an abnormal HbA1C, fasting glucose, and random glucose?
Fasting glucose >100, random glucose >200, and HbA1c >6.5
Which electrolyte imbalance is commonly associated with insulin administration and why? What symptoms would the nurse monitor for?
hypokalemia because insulin moves potassium into the cell; s/s - leg cramps, decreased RR, hypotension, flaccid musles
What kind of labs would the nurse anticipate the provider to order for a patient with HHS?
urine tests for kidney function, BMP for electrolyte levels and BUN and Creatinine for kidney function, specific urine gravity for blood osmolarity level, lipid profile
What is the glucose tolerance test and when is it indicated?
gold standard for diagnosing diabetes; the test is indicated for high-risk women and women that fail the glucose challenge test
What is glucagon and how does it affect serum glucose levels?
the 4 types of insulin and an example of each
rapid-acting = humulin
short-acting = regular insulin
intermediate-acting = nph insulin
long-acting = lantus