Diabetes

high sugar levels (NURS 419)

Type 1

• no working beta cells in pancreas

• not producing insulin

• totally dependent on OS source for insulin (exogenous)

DKA defnintion and etiology

• high sugar levels

• caused by hemorrhaging, truama, sever illness

DKA S+S

• KETONES

• ketoacidosis (metabolic acidosis)

• kussmaul respirations (depep breaths)

• fruity breath (ketones)

• coma/death

DKA Tx

• O2

• fluids (0.9% saline)

• insulin (1:1 ratio)

• K+ levels:

  • <3, hold insulin and give fluids

  • >3, give insulin and fluids simultaneously

Type 2

• insulin resistant in body → eating poorly

• increase glucose in liver → liver releasing sugar you don’t need

• hyperglycemic

• less glucose in tissues

• glycosuria (sugar is urine)

  • obesity metabolic syndrome

catecholamines

• epinephrine → fight/flight → increase glucose levels → need insulin

growth hormone injections

• fight insulin → increase glucose levels because body tells insulin no not release

glucocorticoid hormone

• med. diabetic

where do yo get glucose from?

• liver - released when body senses glucose is low

• skeletal muscle - breaking down muscle to get sugar = ketones

gut shots

• lose weight

• doesn’t allow gut to absorb sugar

• can’t become hypoglycemic

HHS definition and etiology

• high blood sugars (>600)

HHS S+S:

• shock

• dehydrated

• polyuria (K+ loss)

• HR high

HHS Tx

• more difficult to tx due to comorbidities

• fluids

• insulin

• replace K+ if <3.3

FPG Test

• measure amount of glucose in blood

• NL 70 -100

GLP-1 (Incretin Effect)

• gut hormone released post meals

• boosts insulin

• slows stomach emptying → fullness

• happens in SI

hypoglycemia etiology

• low sugar levels

hypoglycemia S+S (sweaty) (mistaken for ETOH abuse)

• sweats (diaphoresis)

• hungry

• shaky/trembling

• stressed/anxious

• weak

• blurred vision

• slurred speech

hypoglycemia Tx

• give anything w/ sugar

• milk and white bread

hyperglycemia etiology

• high sugar levels

• increase blood osmolarity

  • fluid pulled from cells → shrink

hyperglycemia S+S (poly everything) (dry)

• polyuria (lose K+)

• polydipsia

• polyphasia

• fatigue

• warm, dry skin

• cataracts - sugar behind eyes

• bad kidney circulation (nephropathy)

• sugar eat at blood vessels → poor circulation → burning pain (neuropathy)

• shock

hyperglycemia Tx

• hypotonic soln (0.45% NaCl)

A1C (DKA)

• lab drawn q2 months

• determine how glucose is being managed

• <5% - not DM

• 5-6.5% pre DM

• 6.5-7% - DM - good range for DM

• high % tells glucose regulation (sugar is high)

• brittle DM - do anything + glucose shoots up (ex. sneezing)

metabolic syndrome

• large belly

• big waist

• lots of triglycerides (fat) - (150+)

• how HDL (<40-50)

• BP increased

• FPG > 100

T2 BM Tx

1. weight loss plan and metformin

2. add oral meds (not for T1)

3. if worsen, add insulin

4. just insulin (take off everything else)

Gestational DM

• only while pregnant

• may need insulin to protect fetus

Rapid acting Insulin

• before meals and bedtime

• dose based on blood sugar level

• lispro (humalog)

• aspart (novolog)

• onset: 10-20 min

Short acting Insulin

• regular

• only type IV

• onset: 30-60 min

Long acting Insulin

• glargine (lantus)

• onset: 70 min

• no peak (steady)

• take once daily

peak

• if you give 2 insulins and they peak at them same time, pt will be hypoglycemia - give at different time frames

dawn phenomenon

• hypoglycemic while asleep

• body tried to help and release sugars

• issue for DM bc body responds and sugars will be high in the AM

  • look at long acting insulin and give bigger snack before gts

dawn phenomenon Tx

• evening insulin

• reduce carb intake at night

• bedtime snack (protein and fat)

• hydrate

• exercise to use excess sugar

• sleep 6-8 hr

• eat breakfast

somogyi effect

• more rare but stronger

• blood sugar <70

mixing insulin

• clear before cloudy

• never mix long acting

basal insulin

• steady state

• get this in before stopping infusion

bolus insulin

• mealtime or prandial

• used to tx sugars that get worse at meal time

• slowly decrease this first during IV

metformin

• decr. glucose production

• risk: lactic acidosis (don’t give pt with renal failure, heart failure - will gt shock)

• can stop metformin to drink and get back ok metformin after 16h

oral drugs with metformin

• -mide suffix

• last added is first off