Diabetes II

1: less than 7%

2: less than 6.5%

goal A1C for type 1 and 2

Acetone breath

key giveaway for DKA

Missed dose of insulin

ilness or infection

when typically see DKA? [2]

­Polyuria, polydipsia, dehydration (dry mucous membranes, tachycardia), lethargy, weakness, nausea & vomiting, abdominal pain, hyperventilation with Kussmaul respirations (exhalation of excess CO2), acetone breath (sweet, fruity odor)

S+S of DKA:

1. IV access (fluids, electrolytes, IV insulin)

Priority for DKA management

1. check their glucose

2. do head to toe

3. give fluids

4. then IV insulin

When patient presents with DKA< order of nursing care: [4]

1. give bolus dose fast acting

2. set up on sliding scale

3. check glucose every hour and adjust insulin accordingly

4. once glucose reaches 14, add dextrose to iv soln

IV insulin sequence for DKA: [4]

Insulin produced

why don’t patient with type 2 diabetes get DKA?

may not have many symptoms, but eventually will see cognitive thigns - look drowsy, can have seizures, paraulis, numbess and tingling

S+S of HHS

severely dehydrated, more than DKA (rehydrate)

number one priority for HHS

1. monitor glucose, lytes, ketones

2. IV fuids

3. Insulin therapy

4. renal status

5. cardiopulmonary status

6. LOC

Nursing management of DKA and HHS: [6]

­Diaphoresis

­Tremors

­Hunger

­Nervousness

­Anxiety

­Pallor

­Palpitations

S+S of hypoglycemia: [7]

1. give 15-20g carbs

2. recheckafter 15 mins.

3. If still low, repeat 1-2

4. If glucose is more than 4 and meal is more than 1h away, have snack

5. If no improvement with 2-3 doses carbs, give 1mg glucagon IM or 3mg intranasal/ 20-50mL 50% dextrose IV push

what to do if patient’s glucose is below 4

1. cerebrovasc

2. cardiovasc

3. peripheral vasc

Macrovascular damage secondary to chronic hyperglycemia: [3]

1. retinopathy

2. nephropathy

3. neuropathy

4. dermopathy

microvascular damage secondary to chronic hyperglycemia [4]

Nephropathy

damage to vessels that supply glomeruli

Retinopathy

damage to vessels in the retina, may see spots and vision reduced

1. laser photocoagulation therapy

2. virectomy

3. intraocular injection of medications (can reduce intraoccular pressure)

Treatment for diabetic retinopathy [3]

1. ARBs

2. ACE inhibitors

meds to manage BP and can slow progression of nephropathy: [2]

1. microalbuminuria

2. creatinine

3. GFR

regular screening values for nephropahy: [3]

Autonomic neuropathy

neuropathy where all body systems can be affected

1. control blood glucose

2. medications to relieve pain (topical creams, antidepressants, antiseizure medications)

treatment of neuropathy: