NCLEX: Mark Klimek - Lecture 5 (DM, DI, & Insulin)

What is diabetes mellitus?

An error in glucose metabolism.

What are the 2 types of diabetes mellitus?

Type I (Lack of insulin, develops in children)

Type II (insulin resistance, develops in adults)

What is diabetes insipidus?

Lack of ADH, which is a hormone that helps your kidneys manage the amount of water in your body = Dehydration

What are symptoms you see in diabetes mellitus AND diabetes insipidus?

Polyuria and polydipsia

Is there a high or low urine output in diabetes mellitus?

High urine output

Is there a high or low urine output in diabetes insipidus?

High urine output

What is the opposite of diabetes insipidus?

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

What are symptoms in SIADH?

- Oliguria and no thirst

- Decreased urine output

- Retention of water (decreased SERUM specific gravity)

- Decreased urine volume (increased URINE specific gravity)

What is the nursing diagnosis for SIADH?

Fluid volume excess

What is the nursing diagnosis for DM and DI?

Fluid volume deficit

What are other names for Type 1 DM?

Insulin dependent

Ketosis prone

What are other names for Type 2 DM?

Non-insulin dependent

Non-ketosis prone

What are the main s/s of diabetes mellitus?

Polyuria (Pee a lot)

Polydipsia (Thirsty)

Polyphagia (Eat/swallow a lot)

What is the treatment for Type 1 diabetes mellitus?

"If you don't treat Type 1, they will DIE."

(D)iet (calories from carbs, least important)

(I)nsulin (most important)

(E)xercise

What is the treatment for Type 2 diabetes mellitus?

"If you don't treat Type 2, they are DOA."

(D)iet (Most important)

(O)ral hypoglycemic

(A)ctivity

What is the diet for Type 2 diabetes mellitus?

Calorie restriction

1200 kcal, 1400 kcal, 1600 kcal

6 small feedings per day (keeps blood sugar more stable)

What is the best dietary action a DM2 should take?

a. Restrict calories

b. Divide meal into 6 feedings a day

a. Restrict calories

What does insulin do?

lowers blood glucose levels

What are the 4 types of insulin?

Lispro (Humalog): Rapid-acting

R-Regular insulin: Intermediate-acting

N-NPH: Intermediate-acting

Glargine (Lantus): Long-acting

What type of drug is Lispro? What is the onset, peak, and duration?

Rapid-acting, give WITH meal not before (AC)

Onset: 15 min

Peak: 30 min

Duration: 3 hrs

Pattern: 15-30-3

What type of drug is regular insulin? What is the onset, peak, and duration?

Intermediate-acting, CLEAR, IV drip

Onset: 1 hr

Peak: 2 hrs

Duration: 4 hrs

Pattern: 1-2-4

What type of drug is NPH insulin? What is the onset, peak, and duration?

Intermediate-acting, CLOUDY, not in the bag.

Onset: 6 hrs

Peak: 8-10 hrs

Duration: 12 hrs

Pattern: 6-8-10-12

What type of drug is Glargine (Lantus)? What is the onset, peak, and duration?

Long-acting, safely give at bedtime

NO PEAK

Duration: 12-24 hrs

Little to no risk for hypoglycemia

You give 30 units of NPH insulin to a pt at 7 a.m. When do you check for hypoglycemia?

NPH Peak = 8-10hrs

3pm - 5pm

What action by the nurse invalidates the manufacturer's expiration date of insulin?

Opening the package

Once an insulin package has been opened, how long can you keep it?

30 days after opening

An open package of insulin does not have an opening or expiration date on it. What do you do?

Throw it out.

How do you store insulin?

Refrigerator, but is good for up to a month out of the fridge, no heat, no direct sunlight.

Exercise is like getting another shot of...

insulin.

If a student is schedule to play soccer (exercise) this afternoon, what should you do with insulin?

Decrease the dosage OR if already given, give rapidly metabolized carbs (snacks or juice).

Any SICK diabetic patient is going to have two problems:

Hyperglycemia and dehydration

What should you teach a diabetic about sick days?

Serum glucose goes up, so you will need your insulin even if you're eating. Take frequent sips of water to help with increased dehydration.

What are some causes of hypoglycemia in diabetic patients?

Not enough food

Too much insulin

Too much exercise

What does hypoglycemia look like?

Think of a drunk patient in shock.

DRUNK:

- Staggering gait

- Slurred speech

- Labile (Cerebral impairment)

- Slow reaction time

- Decrease social inhibition

SHOCK:

- Tachycardia, tachypnea, low BP

- Cold/clammy, mottled skin

What is the treatment for hypoglycemia?

- Give SUGAR or rapidly metabolized carbs (juice, candy, regular soda, milk, honey, icing, jelly, jam) ** Best bet is sugar + protein/starch. 1 sugar is good, 2 sugars are bad.

- Glucagon IM if parent is on the phone

- Dextrose IV (D10, D50) if in the ER

What are some causes of DKA in a Type 1 diabetic patients?

Ketone = Type 1 DM

Too much food

Not enough insulin

Not enough exercise

Acute viral upper respiratory infection within last 2 wks (#1 cause)

What are s/s of DKA?

(D)ehydration: dry, poor skin turgor, warm

(K)etones in serum, Kussmauls, high K+

(A)cidosis, acetone breath, anorexia due to nausea

Do ketones in the urine mean that you have DKA?

No.

What is the treatment for DKA?

Insulin IV (Regular)

IV FLUIDS! 200 mL/hr (one of the fastest rates)

What is hyperosmolar hyperglycemic nonketotic syndrome (HHNS/HHNK/HHS)?

Nonketotic = Type 2

Dangerously high blood glucose levels in Type 2 diabetics. SEVERE DEHYDRATION!

What is the MAIN complication of HHNS?

SEVERE DEHYDRATION!

Between DKA and HHNS, which is a higher priority?

HHNS - they show up late to the ER.

What are long-term complications of diabetes?

Poor perfusion

Peripheral neuropathy

EX: Renal failure, gangrene, HF, urinary incontinence, lack of feel on foot

What lab test is the best indicator of long-term blood glucose level?

Hb A1C (glycosated Hb or glycosylated Hb)

Normal: <6

Borderline: 7 - needs evaluation

Out of control: >8