Acute complications of Diabetes

Question 1

Manifestations of hyperglycemia

Answer 1

Elevated blood glucose
Increased urination
Increased appetite
Weakness, fatigue
Blurred vision
Mood swings
N/V; headache

Question 2

Causes of hyperglycemia

Answer 2

i. Illness, infection
ii. Corticosteroids
iii. Too much food
iv. Too little or no diabetes meds
v. Inactivity
vi. Emotional or physical stress
vii. Poor absorption of insulin

Question 3

Treatment

Answer 3

Medical care
Continue diabetic meds
Check BG & Urine Ketones
Drink fluids

Question 4

Caused by profound deficiency of insulin

Answer 4

Diabetic Ketoacidosis (DKA)
type 1

Question 5

DKA characterized by

Answer 5

i. Hyperglycemia
ii. Ketosis (body burns fat for energy)
iii. Acidosis
iv. Dehydration

Question 6

DKA precipitating factors

Answer 6

i. Illness
ii. Infection
iii. Inadequate insulin dosage
iv. Undiagnosed type 1 diabetes
v. Lack of education, understanding, or resources
vi. Neglect

Question 7

W/O treatment of DKA

Answer 7

i. Severe depletion of sodium, potassium, chloride, magnesium, and phosphate
ii. Acidosis -> vomiting and further fluid and electrolyte losses
iii. Elevation of BS-greater than 300, ketoacidosis; electrolyte imbalance (leads to dehydration)

Question 8

Hypovolemia followed by shock can cause

Answer 8

renal failure; causing mention of ketones & glucose; further acidosis

Question 9

DKA clinical manifestations

Answer 9

Dehydration

Early: Lethargy & weakness

Question 10

DKA s/s

Answer 10

1. Skin dry and loose; eyes soft and sunken
2. Abdominal pain, anorexia, nausea/vomiting
3. Kussmaul respirations
4. Sweet, fruity breath odor (acetone)

Question 11

Emergency management DKA: first

Answer 11

ensure pt airway; administer O2

Question 12

Emergency management DKA: second

Answer 12

Establish IV access; fluid replacement

Question 13

Protect from what with emergency treatment of DKA

Answer 13

Cerebral edema
monitor fluid overload
Monitor/ replace K before starting insulin therapy

Question 14

to correct hyperglycemia and ketosis

Answer 14

IV regular insulin drop 0.1 U/kg/hr

Question 15

a. Life-threatening syndrome; less common than DKA; b. No breakdown of fat; no acidosis; type 2 diabetes

Answer 15

Hyperosmoler Hypegylcemia Syndrome (HHS)

Question 16

i. Able to make enough insulin to prevent DKA but still have severe hyperglycemia, osmotic diuresis, and ECF depletion

Answer 16

HHS

Question 17

Common causes of HHS

Answer 17

i. UTIs, pneumonia, sepsis (infection)
ii. Acute illness
iii. Newly diagnosed type 2 diabetes
iv. Impaired thirst sensation and/or inability to replace fluids

Question 18

First step for treatment of HHS

Answer 18

More fluid replacement

Question 19

Second step for treatment of HHS

Answer 19

IV insulin infusion

Question 20

Monitor what with HHS

Answer 20

Fluid; electrolytes (K*), serum osmolality

Question 21

DKA/HHS management monitor

Answer 21

BG
Urine output & ketones 
IV fluids
Insulin therapy
Electrolytes, K

Question 22

DKA/HHS management Assess

Answer 22

Renal status
Cardiopulmonary status
LOC

Question 23

b. Blood glucose level < 70 mg/dL

Answer 23

Hypoglycemia

Question 24

Hypoglycemia causes

Answer 24

i. Alcohol intake without food
ii. Too much insulin or oral hypoglycemic agents
iii. Too little food
iv. Delaying time of eating
v. Too much exercise

Question 25

Hypoglycemia manifestations

Answer 25

``` Cool, clammy skin Numbness Tachycarida Nervousness, tremors Hunger Vision changes ```

Question 26

Altered mental function— “neuroglycopenia”

Answer 26

i. Difficulty speaking ii. Visual disturbances iii. Stupor iv. Confusion v. Coma

Question 27

Treatment of Hypo

Answer 27

Rule of 15 low: 15 g of carb Wait 15 min check, glucose

Question 28

IF BG is less than 70 after giving 15 g carb

Answer 28

Eat or drink another 15 g

Question 29

iii. If stable and meal more than 1 hour away or involved in an activity

Answer 29

Give carb or protein (peanut butter crackers; slice of cheese

Question 30

If glucose remains low after 2 to 3 times

Answer 30

Call HCP or EMS

Question 31

Treatment in acute care settings

Answer 31

50% dextrose 20 to 50 mL IV push; if they are not alert enough to swallow

Question 32

Avoid what with treatment of hypoglycemia

Answer 32

fat type carbs; cookies; milk- delays response to action

Question 33

Preventative measures

Answer 33

i. Take meds as prescribed on time ii. Accurately administer insulin, noninsulin injectables or OAs iii. Coordinate eating with meds iv. Eat adequate food as needed with exercise v. Recognize and treat symptoms and teach family/caregiver vi. Carry simple carbohydrates vii. Wear or carry diabetes ID

Question 34

a. No warning signs/symptoms until glucose level critically low i. Incoherent, combative, loss of consciousness

Answer 34

Hypoglycemia unawareness

Question 35

``` DKA labs Blood glucose blood pH Serum bicarbonate Ketones ```

Answer 35

5. Blood glucose level of greater than or equal to 250 mg/dL 6. Blood pH lower than 7.30 7. Serum bicarbonate level less than 16 mEq/L 8. Moderate to high ketone levels in urine or serum