265 Diabetes
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| Symptoms for mild hypoglycemia | BG<60;trembling,shaking, sweating,rapid HR, headache,hunger tingling of extremities,
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| Symptoms for Severe hypoglycemia | BG<40; confusion, strange behavior, slurred speech, blurry vision, numbness, trouble concentrating, irriability, seizure, coma
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| What is the signifigance of beta blockers with diabetic patients? | they cause less severe/obvious symptoms
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| examples of beta blockers | Propandolol (Inderal, Dentensol)
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| treatment for sulfonyurea-induced hypoglycemia | Diazoxide (Proglycem) or Sandostatin
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| Drug Treatment Hypoglycemia (patients that cannot swallow) | Glucagon (IM,SUBQ, causes voimiting) with D50, if pt cant swallow (avoid extravasation)
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| Dawn Phenomenon | nighttime release of GH that causes hypoglycemia between 5-6am--give intermediate insulin @HS
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| Somogyi Phenomenon | morning hyperglycemia from counterregulatory response to nighttime hypoglycemia--give food@night
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| Sick day rules | tell MD that u are sick, monitor BGq4h, test ketones when BG=240; keep taking meds, prevent dehydration,cant eat--liquids=carb content of usual meal
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| Sick day rules--Call MD if... | Persistent N&V, mod-large ketones, BG rises after 2 doses of insulin, High temp (over 101.5) for more than 24rs
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| Counter regulatory hormoes | Glucagon (main), GH, epinephrine, norepinephrine, cortisol
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| Polyuria | frequent/excessive urine results from osmotic diuresis caused by excessive glucose in urine
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| Polydipsia | excessive thirst; result of diuresis--Sodium, chloride, potassium are excreted, H20 loss is severe-->dehydration
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| Polyphagia | cells have no glucose, starvation occurs, they will stay in starvation mode until insulin is available to move glucose into cells
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| Dehydration that occurs with diabetes leads to... | Hemoconcentration, Hyperviscosity, hypovolemia, hypoperfusion & hypoxia
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| Hypoxic cells dont metaboiize glucose effectively so what occurs | Kreb cycle is blocked, lactic acid increases causing more acidosis
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| Metabolic acidosis | excess acid causes an increase in Hydrogen ions & carbon dioxide levels in blood
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| Kussmauls | respirations increaes in rate & depth to try & get rid of CO2 & acid
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| metabolic acidosis ABGs show | decreased pH & decreased bicarb (HCO3)
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| Risk factors for Metabolic syndrome | FBG>100;BP>120/80;Triglyceride>150; Large waist circumference-men40, women35; decreased in HDL-men40, women-50
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| Interventions for Metabolic syndrome | healthy heart diet (DASH); Loss of 5-10% of body wt, smoking cessaion, exercise
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| what do counter regulatory horomes do? | inhibit isulin production--raise BG levels
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| Hemoglobin A1c (normal) | 5.7
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| Hemoglobin A1c (pre-diabetic) | 5.7-6.4
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| hemoglobin A1c (diabetes) | 6.5 or higher
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| Alpha cell secrete | Glucagon (sustains glucose when fasting)
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| Beta cells secrete | Insulin
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| Delta cell secrete | Somatostatin
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| Type I | Beta cells make little/no insulin--autoimmune
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| Type II | decreased production/utlization--increased insulin resistance
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| Gestational | Placenta hormones need more insulin (3times); secretes excessive epinephrine &norephinreine (not enuff to stablize BG levels)
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| Basal insulin | 24 insulin production(intermediate & long acting) Lantus, NPH, Levemir
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| Prandial | needed during meeal (short & rapid) regular, novolog, humalong, apidra
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| How is diabetes diagnosed? | FBG of 126 on 2 more occasion (fast 8h); 3hr glucose tolerance test--over 200
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| How is pre-diabetes diagnosed? | FBG of 100-125; 2hr post load glucose 140-199 (fast for 10-12hrs)
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| What is DKA? | absence/inadequate amt of insulin--results in disorders in metabolisms of carbs, fats proteins
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| DKA--How does body respond to insulin deficit? | pulls from stored glycogen, protein & fat stores for energy
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| Byproduct of fatty metabolism | FFA--Glycerol--Ketones(drops pH)-Metabolic acidosis
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| DKA--Signs & symptoms | 3Ps, blurry vision, fatique, dehydation, dry mouth, itchy skin, low BP, increased HR, weakness, altered LOC, NV, abd pain, Kussmauls, coma, death
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| DKA--Management--drug therapy | goal to lower BG by 75-150/hr; MILD-subQ Moderate to severe--reg. insulin by continous IV OR inital bolus 0.1unit/kg followed by IV insulin drip 0.1 unit/kg/hr; assess BG qhr
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| DKA--management--assesments | 1st assess airway, LOC, hydration status, electrolytes & BG levels; Check BP,RR,HR q15min; stable--q4h; urine output, temp & LOC q1h
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| DKA--Fluid management | 1st-1L NS over 30-60min,(2nd liter given in next half hr, restores volume & maintains perfusion) 2nd-).45%NS slowly (replaces total body fluid loss
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| DKA--acidosis management | assess for hypokalemia; before giving IV K+ patient needs 30ml urine/hr, bicarb is used only in severe acidosis; sodium bicarb given slowly IV over several hrs pH<7 & HC03<3
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| DKA--signs of hypokalemia | fatigue, confusio, muscle weakness, shallow res, abd distention, paralytic ileus, hypotension, weak pulse
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| DKA--why is bicarbonate only given in severe cases? | can reverse acidosis too fast, & lead to severe hypokalemia
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| DKA--patient/family teaching | check BG q4-6hr, check ketones, drink 3L, with nausea-liquids w/glucose & electrolytes, vomiting-8-12oz calorie free liquids, 150g of carb,
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| Only insulin that can be given IV | regular
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| In acute stages insulin can be given | SubQ & IM
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| Management of DKA (Basham) | electrolyte replacement, check renal function, foley (stict I&O), ABGs (bicarb may/may not be given), EKG, correction scale
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| DKA--ABGs show | decreased HCO3, CO2, and pH
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| fatty acids are used when... it is stored? | glucose is not available; stored in cells
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| incretin hormones are secreted in response to...increases what secretion? stops what? slows what? | food in tummy, increases insulin secretion, stops glucagon & slows rate of of gastric emptying
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| Main fuel for CNS | Glucose, brain cant store/make much of it, it needs constant supply to prevent neural dysfunction & cell death
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| Insulin is needed to move____into cell; without it body breaksdown____ | glucose; w/o it body breaks down fats/proteins
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