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Diabetes Part 2
 

Diabetes Part 2

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    Diabetes Part 2 Diabetes Part 2 Presentation Transcript

    • Care of Clients with Diabetes Mellitus
      1
      Part2 - Complications
    • 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
    • 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
    • Acute complications
      Hypoglycemia
      Diabetic ketoacidosis: DKA
      Hyperosmolar hyperglycemic syndrome: HHS
      4
    • Hypoglycemia-causes
      Too little food- or delayed
      Too much diabetic medicine
      Too much exercise without compensation
      Alcohol intake without food
      5
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Diabetic ketoacidosis (DKA)- etiology
      Too little insulin with increased caloric intake
      Physical or emotional stress
      Undiagnosed DM
      13
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • HHS
      Causes:
      infection: UTI, pneumonia, sepsis
      inadequate adherence with insulin regimen
      new diagnosis of diabetes
      Triggers:
      MI & CVA
      Surgery
      Pancreatitis
      Medications
      Pregnancy
      24
    • HHS- symptoms
      Reflect dehydration & altered CHO, fat, & protein metabolism
      Thirst
      Tachycardia
      Polyuria
      Fatigue
      Weight loss
      Blurred vision
      Altered mental status
      Coma
      25