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Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
Diabetes Part 2
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  • 1. Care of Clients with Diabetes Mellitus
    1
    Part2 - Complications
  • 2. Somogyi effect
    Periods of hypoglycemia followed by rebound hyperglycemia
    Hypoglycemia causes some diabetics to release epinephrine
    Decrease evening dose or move to bedtime
    or increase bedtime snack
    Diagnose with a 2 or 3 am blood sugar
    2
  • 3. Dawn phenomenon
    Nocturnal release of growth hormone- leads to an increase in glucose around 4-8 am; normal for everyone
    Treat with increase of evening insulin or move supper insulin to bedtime
    More severe in adolescence
    3
  • 4. Acute complications
    Hypoglycemia
    Diabetic ketoacidosis: DKA
    Hyperosmolar hyperglycemic syndrome: HHS
    4
  • 5. Hypoglycemia-causes
    Too little food- or delayed
    Too much diabetic medicine
    Too much exercise without compensation
    Alcohol intake without food
    5
  • 6. Hypoglycemia- symptoms
    Tremors, Nervousness
    Irritability, personality changes, abnormal behavior
    Cool, clammy skin with diaphoresis
    Increased heart rate
    Hunger, Headache
    Unsteady gait, slurred or incoherent speech
    Vision changes: double or blurred vision
    Seizures, coma
    6
  • 7. Hypoglycemia- management
    Immediate ingestion of 15 g. of simple CHO
    4 oz of juice
    4 oz of regular soda
    1 tablespoon of honey or syrup
    2 tablespoons of raisins
    3-4 hard candy
    Commercial dextrose product: 3-4 tablets
    7
  • 8. Hypoglycemia- management
    Repeat tx if no improvement in 15 min.
    If not eating a regular meal within the next
    1-2 hours follow with additional food that contains protein & CHO
    4 oz milk, slice of bread, peanut butter & crackers
    8
  • 9. Hypoglycemia- severe reaction
    50% Dextrose: IV
    20-50 ml
    Followed by infusion of D5W
    Glucagon: subcutaneous or IM
    .5- 1 mg
    Raises the blood glucose level by 20-30 within a few minutes
    Person should eat as soon as regain consciousness
    Causes N/V
    9
  • 10. Glucagon
    Glucagon can cause vomiting, so be sure to place the person on his or her side prior to injecting so they do not choke. After injecting glucagon, follow with food once the person regains consciousness and is able to swallow.
    10
  • 11. Hypoglycemia: severe
    Glucose gel or cake icing gel can be put on the cheek inside the mouth
    Honey rubbed into gums also has worked
    Inform patients to always wear medical alert identification
    11
  • 12. Hypoglycemia: severe
    15 grams of fast acting CHO will raise blood glucose by approximately 45 points in 10-15 minutes
    Do not treat with high-fat foods: chocolate, ice cream
    Over treatment is common
    12
  • 13. Diabetic ketoacidosis (DKA)- etiology
    Too little insulin with increased caloric intake
    Physical or emotional stress
    Undiagnosed DM
    13
  • 14. DKA: Too little insulin
    Glucose cannot enter cells & be used for cellular energy
    Body releases & breaks down stored fats & proteins to provide needed energy
    Free fatty acids from stored triglycerides are released & metabolized in the liver in such large amounts that ketones are formed.
    Excess ketones- Acidosis
    14
  • 15. DKA-Pathophysiology
    Hyperosmolarity: hyperglycemia (glucose > 250) dehydration (serum osmolarity normal or just above normal)
    Fluid & electrolyte imbalance: osmotic diuresis
    Metabolic Acidosis
    PH < 7.30 Norm: 7.35- 7.45
    HCO3 < 15 Norm: 22-26
    Urinary ketones >3+ Norm: 0
    15
  • 16. DKA- symptoms
    Develops rapidly over 24 hours
    Increased blood glucose- > 250 mg/dl
    Abdominal pain, N/V
    Kussmaul’s respiration
    Acetone noted on breath- fruity
    Hypotension
    16
  • 17. DKA- treatment
    Insulin: IV infusion of regular insulin
    Replacement of fluids to correct hypovolemia
    NS 10-20 ml/kg of body weight over first 1-2 hours
    17
  • 18. DKA- treatment
    Correct electrolyte imbalance
    Changes in serum potassium, calcium, magnesium, & phosphate can occur
    Hyperkalemic: potassium can’t get into the cells without insulin. When administer insulin the potassium reenters the cell & patient runs a risk for hypokalemia
    18
  • 19. DKA: Nursing Interventions
    Take hourly glucose levels
    Obtain ABG’s
    Monitor electrolytes every 1-4 hours
    Cardiac monitor to watch for dysrhythmias
    Assess every 1-4 hours
    VS
    Urine output
    Neurologic status
    19
  • 20. DKA: complication
    Cerebral edema
    Can occur 6-10 hours within start of treatment
    Occurs when blood glucose falls too rapidly: causing fluid to shift into the brain cells
    Can also occur with sodium levels dropping too rapidly. Fluid replacement must be monitored carefully
    20
  • 21. DKA
    Once the patient’s blood glucose is stable and the patient can have food by mouth or through a feeding tube, subcutaneous insulin can begin
    Give first subcutaneous insulin 1-2 hours before you discontinue the insulin infusion
    21
  • 22. Sick Day Management
    When sick:
    Always take diabetes medicine
    Test glucose at least every 4 hours
    Call the doctor if:
    Blood glucose consistently > 250 mg/dl
    Ketone test is moderate to high
    Feel sick & vomit
    Think you might have an infection
    Keep well hydrated
    Replace foods with liquids that contain CHO
    22
  • 23. Hyperosmolar hyperglycemic syndrome- HHS
    Severe hyperglycemia > 600 mg/dl
    Takes days or weeks to fully develop
    Type 2 diabetes with diminished renal function &/or cardiac disease
    23
  • 24. HHS
    Causes:
    infection: UTI, pneumonia, sepsis
    inadequate adherence with insulin regimen
    new diagnosis of diabetes
    Triggers:
    MI & CVA
    Surgery
    Pancreatitis
    Medications
    Pregnancy
    24
  • 25. HHS- symptoms
    Reflect dehydration & altered CHO, fat, & protein metabolism
    Thirst
    Tachycardia
    Polyuria
    Fatigue
    Weight loss
    Blurred vision
    Altered mental status
    Coma
    25

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