Diabetes Flashcards
(42 cards)
Long term complications of DM
- Blindness
- ESRD
- Non-traumatic lower limb amputation
What is DM a major risk factor for?
- Heart disease
- Stroke
- HTN
- High cholesterol
Functions of insulin
- Transports & metabolizes glucose for energy
- Stimulates storage of glucose in liver
- Signals liver to stop release of glycogen
- Enhances storage of dietary fat & adipose tissue
- Accelerates transport of amino acids into cells
- Inhibits breakdown of stored glucose, protein, fat
What causes glycosuria?
Concentration of glucose is > 180-200 —> kidneys cannot reabsorb all the glucose & it is excreted in urine
What accompanies glycosuria?
Excessive loss of F&E
Osmotic diuresis
Loss of glucose in urine —> excessive loss of F&E
Components of metabolic syndrome
If pt has 3/5 = metabolic syndrome —> increased risk of heart disease, DM, stroke
- Elevated glucose
- Abdominal obesity
- Elevated BP
- High triglycerides
- Decreased HDL
When can DKA occur in type 2?
Severe illness or stress when pancreas cannot meet extra demand for insulin
Risk factors for type 2
- Obesity
- Age
- Previous impaired fasting glucose or glucose tolerance test
- HTN
- HDL < 35
- Triglycerides > 250
- HX of gestational DM or baby > 9 lbs
Clinical manifestations
- Polyuria, polydipsia, polyphagia
- Fatigue, weakness
- Vision changes
- Tingling/numbness of hands & feet
- Dry skin, skin lesions or wounds that won’t heal
- Recurrent infections
- Type 1 may have sudden weight loss
Diagnostic criteria
- Fasting glucose 126 or more
- Casual glucose exceeding 200
- S/S
3 main causes of DKA
Severe deficiency of insulin
- Decreased or missed dose
- Illness or infection
- Undiagnosed or untreated DM
What may be the initial manifestation of type 1?
DKA
DKA is commonly preceded by a day or more of…
- Polyuria
- Polydipsia
- N/V (S/T acidosis)
- Fatigue —> eventual stupor & coma if not treated
- Acetone breath
Clinical features of DKA
- Hyperglycemia
- Dehydration w/electrolyte loss
- Acidosis
How much water & electrolytes can be lost due to DKA?
- 6.5 L water
- 400-500 mEq EACH of Na, K, Cl
What is the initial goal of therapy for DKA?
Establish IV access and begin F&E replacement
What is the cause of metabolic acidosis in DKA?
Ketosis alters pH balance —> metabolic acidosis
Why does illness & infection cause DKA?
The body increases stress hormones (glucagon, Epi, norepinephrine, cortisol, GH) in response to stress —> hormones promote glucose production & interfere with glucose utilization
“Sick day” rules
- Take insulin or PO meds as RX’d
- Test blood glucose & urine ketones Q3-4 hrs
- Report elevated glucose to PCP
- Take supplemental doses or regular insulin Q3-4 hrs PRN
- Substitute soft foods 6-8 times per day if unable to follow normal meal plan
- Take liquids (cola, OJ, broth, gatorade) Q30 min to prevent dehydration & prevent calories if N/V or fever present
- Report N/V/D to PCP
- Be aware if unable to retain fluids —> hospitalization to avoid DKA
Clinical manifestations of DKA
-Dry mouth
-Thirst, polydipsia
-Polyuria, urinary frequency
-Fatigue, weakness
-Blurred vision
-HA
IF volume depletion: orthostatic hypotension, rapid/weak pulse
What symptoms can ketosis & acidosis lead to?
GI
- Anorexia
- N/V
- Abdominal pain
- Acetone breath
- Kussmaul respirations
- AMS - gradually increasing restlessness, confusion, lethargy; patient can be alert, lethargic, or comatose
Hourly assessment for DKA
- VS
- Fluid volume status
- ABGs
- Breath sounds
- Mental status, neuro status (cerebral edema)
- Blood glucose level
- Continuous ECG for arrhythmias (low K)
What causes renal failure in DKA?
Hypovolemic shock
