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, Phenytoin (Dilantin), TPN, stressful event (surgery)
Why would a client have an elevated BG in the morning even after taking evening insulin?
The Somogyi effect: when the insulin causes a decrease in BG and the release of hormones causes a rebound increase to attempt homeostasis
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?
Lack of serum/urine ketones
5 symptoms of a patient 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 80-110
3 education points for the patient 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 patient in DKA
Confusion, Disorientation, Thirst, Weight loss, tachycardic, 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 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.
Name the four ways that a client is screened for Type 2 DM.
(BBOL): BP, BG, Obesity, and Lipids
What is the best way to prevent diabetes associated complications
Tight glycemic control
What ABG findings would a patient with DKA have?
Metabolic acidosis, low pH 7.2, low HCo3 <16, generally low CO2 follows as the respiratory system tries to buffer acidosis in the body
Name three common causes of HHS
Infection, dialysis, medications (thiazide-diuretics for BP management)
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 Type 2 patient comes to the clinic with an A1C reading of 8.4. What lifestyle modification/education is needed? Name 4 items.
Aerobic exercise 150 min/week, Goal for blood glucose 80-110, Consistent low carb diet, low glycemic foods, eat consistently, check blood glucose as recommended by MD
How might a patient describe neuropathy? What medications would help to treat this condition?
Tingling, burning, shooting pain, Gabapentin (Neurontin), Pregabalin (Lyrica)
What is a priority intervention for a patient in DKA?
Safety, glucose management, hydration with IVF (LR, 0.9% NS , potassium replacement, and hourly BG checks
What is the priority intervention for a client with HHS?
Fluid replacement
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
When might a patient need to check their glucose levels- name 4 incidences
Prior to administering insulin, prior to meals, if they feel 'low'- hypoglycemic, if they feel 'high'- hyperglycemic, before exercising, before bed
Pt 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 3 P's, Sick day plan from endocrinologist
Name 4 types of complications resulting from uncontrolled diabetes
nephropathy, neuropathy, retinopathy, poor wound healing
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