NON-DKA, hypoglycemia

Question 1

metabolic complications

Answer 1

-DM is same thing as having HF same risks?? she said this
-Acute
-DKA
-HHNK
-Hypoglycemia

-Chronic
-Macrovascular- Cardiovascular disease; cerebrovascular disease
-Microvascular:
-Retinopathy
-Nephropathy
-Neuropathy

Question 2

HHNK (hyperglycemia, hyperosmolar nonketotic syndrome)

Answer 2

-MC occurs in older adults with type 2 diabetes
-always look for precipitating factors

Question 3

factors associated with HHNK

Answer 3

-Drugs
-Procedures
-Chronic illness
-Acute illness
-K is not as urgent bc insulin is present

-4 major clinical features
-Severe hyperglycemia
-No or slight ketosis
-Profound dehydration
-Hyperosmolality
-Complications: MI, Stroke, PE, Mesenteric vein thrombosis, DIC
-No acidosis
-The severe dehydration and low output state may predispose the patient to complications such as MI, stroke, PE, mesenteric vein thrombosis, and disseminated intravascular coagulation

Question 4

treatment

Answer 4

-similar to DKA
-Volume replacement
-Insulin
-Find underlying cause

Question 5

hypoglycemia

Answer 5

-AKA insulin reaction or hypoglycemia reaction

Question 6

hypoglycemia risk factors

Answer 6

-Overdose of insulin/hypoglycemic medication
-Omitting a meal
-Overexertion
-Nausea and vomiting
-Alcohol intake

Question 7

symptoms of hypoglycemia

Answer 7

-ADRENERGIC:
-Shakiness
-Irritability
-Nervousness
-Tachycardia
-Tremor
-Hunger
-Diaphoresis
-Pallor
-Paresthesias

-NEUROGLYCOPENIC:
-Headache
-Mental illness
-Inability to concentrate
-Slurred speech
-Blurred vision
-Confusion
-Irrational behavior
-Lethargy
-LOC, coma, seizure

-diff dx- hypothyroid, stroke

Question 8

hypoglycemia interventions

Answer 8

-Mild- carbohydrate 10-15 gram*

-Moderate:
-20-30 gram of carbohydrates*
-Glucagon, 1 mg IM - if unconscious

-Severe:
-50% dextrose 25 g IV
-Glucagon 1 mg IM or IV

Question 9

hypoglycemia other complications: somogyi phenomenon

Answer 9

-tendency of the body to react to extremely low blood sugar (hypoglycemia) by overcompensating, resulting in high blood sugar
-hormones can change at night and affect sugar
-Somogyi effect, also known as the “rebound” effect
-adjust nighttime insulin

Question 10

hypoglycemia other complications: dawn phenomenon

Answer 10

-Hormones (growth hormone, cortisol, and catecholamines) release large amounts of glucose: released in the early morning hours: may partially block the effect of insulin,—-hyperglycemia ensues
-adjust nighttime insulin

Question 11

diabetic client and surgery

Answer 11

Preoperative care- stop PO and start injection insulin

Intraoperative care

Postoperative care

Question 12

sick days and diabetes

Answer 12

-Individualized plan
-Monitoring:
-glucose levels
-ketones
-insulin
-nutrition
-fluids

-Know when to call the Clinician