NURS 312: Lab 5 - Hyperglycemia

What is diabetes mellitus?

A common, complex, chronic condition in which the ability to produce or utilize the hormone insulin is impaired, resulting in impaired glucose metabolism, and can affect the function of all body systems.

What is type I diabetes?

Type of diabetes characterized by impaired ability of pancreas to produce insulin.

What is type II diabetes?

Type of diabetes characterized by insulin resistance.

Beta cells produce insulin while alpha cells produce glucagon in the islets of Langerhands in the pancreas (True/False).

True

1 multiple choice option

Insulin promotes glucose release while glucagon promotes glucose uptake (True/False).

False

What is a stable BGM?

4-6 mmol/L

What is are some causes of type I diabetes?

- Autoimmune disorder

- Viral infection

What are some causes of type II diabetes?

- Hyperlipidemia

- Hypertension

- Increased clot formation

- Heredity

- Environment

- Metabolic syndrome

What is included in metabolic syndrome?

- Abdominal obesity

- Hyperglycemia

- Hypertension

- Hyperlipidemia

What are some diagnostic tests used for diabetes?

- Hemoglobin A1C

- Fasting glucose

- Random glucose

- Two hour oral glucose tolerance test (OGTT)

What is the most accurate and recommended test for diabetes?

Hemoglobin A1C.

What is hemoglobin A1C?

The average blood glucose level during the previous 120 days.

What is considered a diabetic A1C level?

≥6.5%

What is considered a diabetic fasting blood glucose?

≥7 mmol/L.

What is considered a diabetic random glucose?

≥11.1 mmol/L.

What is considered a diabetic OGTT?

≥11.1 mmol/L.

When is OGTT usually measured?

During pregnancy.

What are some s/s of hyperglycemia?

- Polyuria

- Polydipsia

- Polyphagia

- Elevated BG

- Blurred vision

- Weight loss

- Weakness/fatigue

- Abdominal cramping

What is diabetic ketoacidosis (DKA)?

A severe acute complication of diabetes, characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased production of ketones.

What are some s/s of DKA?

- Hyperglycemia

- Glucosuria

- Polyphagia

- Polyuria

- Ketouria

- Severe dehydration

- Abdominal pain

- Kussmaul respirations

- Fruity breath

- Weakness

- Confusion

What are 3 things needed for a DKA diagnosis?

- Hyperglycemia

- Metabolic acidosis

- Ketosis

What are the top priorities for DKA?

- Airway and oxygen administration

- LOC and vital signs

- Hydration status and IV access

- Electrolytes and BGM

What IV fluid should be run for fluid resuscitation during the first hour for hyperglycemia?

NS 0.45% or NS 0.9%.

At what rate should the IV fluid run for the first hour for a hyperglycemic patient?

15-20ml/kg/h.

What IV fluid should be run for fluid resuscitation for a hyperglycemic patient with a BG of 13.8 mmol/L?

D5 1/2 NS.

IV insulin should be started before IV fluids for a hyperglycemic patient (True/False).

False

1 multiple choice option

What should be done if blood glucose drops too quickly during IV insulin infusion?

Dextrose solution should be increased.

How many units of insulin should IV insulin run at?

5 units/h.

Hypokalemia should be addressed first before hyperglycemia (True/False).

True

1 multiple choice option

What are some s/s of hypokalemia?

- Fatigue

- Malaise

- Confusion

- Muscle weakness

- Shallow respirations

- Abdominal distension

- Paralytic ileus

- Hypotension

- Weak pulse

- Shock

What are some s/s of hyperkalemia?

- Chest palpitation

- Bradycardia

- Hypotension

- Tall, peaked T waves

- Prolonged PR intervals

- Flat or absent P waves

- Wide QRS complexes

- Twitching

- Tingling

- Burning sensation

- Diarrhea

- Hyperactive bowel sounds.

When is bicarbonate given to a patient with DKA?

When pH is ≤7.0 or bicarbonate is ≤5mmol/L.

What is the Dawn phenomenon?

A nighttime release of adrenal hormones causing blood glucose to spike in the morning.

How is the Dawn phenomenon managed?

More insulin is given at night.

What is the Somogyi phenomenon?

The counter regulatory response to the Dawn phenomenon.

What is a hyperglycemic-hyperosmolar state (HHS)?

A hyper-osmolar state caused by sustained osmotic diuresis leading to extremely high blood glucose.

During HHS, there is a very high blood glucose level while having little to no ketones (True/False).

True

1 multiple choice option

DKA is causes by a decreased amount of insulin, while HHS is caused by a lack of insulin (True/False)

False

1 multiple choice option

What are some s/s of HHS?

- Hyperglycemia

- Glucosuria

- Polyuria

- Dehydration

- Polyphagia

- Polydipsia

- Hypernatremia