Mark K Lecture 5: Diabetes Mellitus, Diabetes Insipidus, SIADH, Insulin, DKA, HHNK

diabetes mellitus

an error in glucose metabolism... glucose is the body's primary fuel source

- can be caused by a lack of insulin DM1

- can be insulin resistance DM 2

diabetes insipidus

Not a type of DM.. it is insidious, diabetes, w/ out the glucose element

- it is polyuria, polydipsia leading to dehydration, due to low ADH

- like DM but, it is just the fluid part

so the question is about to low urine or high urine output?

- DI ALSO has polyuria and polydipsia

lots of urine retained, specific gravity is low =

SIADH

Fluid Volume Deficit=

DM, DI

Fluid Volume Excess =

SIADH

DM Type 1

insulin dependent, Ketosis prone

DM Type 2

non- insulin dependent, non ketosis prone

S/Sx of DM

polyuria, polydipsia, polyphasia

tx for DM type 1 "DIE"

diet, insulin, exercise

they are DOA

diet, oral hypoglycemic, activity

txt for DM type 2

diet!!

calorie restiction

these patients need 6 small meals a day as this keeps blood sugar more stable

R- regular insulin

short acting!

CLEAR

O: 1hr

P: 2hrs

D: 4hrs

1-2-4

N-NPH

Intermediate insulin is CLOUDY

N- no IV drip

O:6hrs

P: 8-10hrs

D: 12 hrs

6-8-10-12

Lispro (Humalog)

rapid acting insulin

O:15 minutes

P: 30 minutes

D: 3 hrs

15-30-3

Glargline (Lantus)

long acting insulin

no peak

D: 12-24 hours

little to no hypoglycemia

what does hypoglycemia look like?

a drunk person in shock

staggering gate, slurred speach, labile, tachycardia, tachypnea, low bP, cold clammy= give candy!

DKA causes

too much food, not enough insulin, not enough exercise

#1 cause is an URI

DKA s/sx

dehydration, ketones, kussmals, acidosis, acetone break, anorexia

DKA tx

regular insulin and fluids!

HHNK or HHS or HHNS

high BP in a DM type 2

dehydration!

#1 diagnosis : fluid volume deficit

#1 intervention: rehydration

success when UO increases, moist mucous membranes

long term comps: poor perfusion, peripheral neuropathy

which test is the best indicator of long-term blood glucose level

Hb (hemoglobin) A1C glycosated Hb

< 6 is normal

> 8 is out of control

7 is borderline