- Rapid, shallow breaths in an attempt to excrete more CO2 and acid - breathing is first rapid and shallow, but as acidosis worsens, breathing gradually becomes deep, labored and gasping. It is this latter type of breathing pattern that is referred to as Kussmaul breathing.
hunger - excessive eating
thirst - excessive intake of water
Frequent & excessive urination
what is basal insulin secretion?
- it is insulin secreted at low levels during fasting - basal levels of insulin are secreted continuously to control metabolism
What three things happen when there is no insulin?
1. ⬆ Blood glucose (b/c insulin isn't converting glucose to go into cells) - Cell starvation → polyphagia = water goes into bloodstream so intracellular dehydration occurs, sugar doesn't get into cell so it stimulates hunger - kidneys eliminate glucose with water → polyuria and polydipsia
2. Ketones from abnormal fat breakdown are - eliminated in urine (polyuria) and - eliminated in breathing = Acetone breath (fruity) (kussmuals respirations)
3. Acids from abnormal protein breakdown are - eliminated in urine = polyuria, acid base imbalances [esp. k!]) and - eliminated in breathing (kussmuals respirations)
1. Physical exam- VS, appearance (thin or overweight) 2. Medical Hx- family hx, eating habits (thirsty), recent illness, medications 3. Blood Tests
What are ketones and how are they generated?
-should not be present in urine or blood -result from fat breakdown because there isn't enough glucose
What are the four levels of ketone measurements?
1. negative 2. Small 3. Moderate = fat breakdown somewhere 4. Large = severe lack of insulin - if they are losing weight & have ketones, but no hyperglycemia, then its suggests weight loss is occurring w/o disrupting blood glucose control
-lead to nephropathy / neuropathy / retinopathy (kidneys, nerves, eyes)
What are Macrovascular complications?
- large blood vessels
- coronary heart disease / cerebrovascular disease / peripheral vascular disease (plaque build up in arteries)/ early death
What should the calories be in a diabetic diet?
- calories to maintain weight (1600-1800 or 1900-2100) - someone in the hospital typically 1500-1800
What amount of protein should be in a diabetic diet?
- 15-20% of total daily - less if renal impairment
What amount of fat should be in a diabetic diet?
- less than 30% total daily - avoid cholesterol and saturated fats
What amount of carbs should be in a diabetic diet?
- 50-60% of total - can eat sucrose foods - want complex carbs b/c they will last longer
Alcohol and Diabetes (3)
1. moderate intake with food is safe (men ≤2/day, women ≤1/day) 2. may cause hypoglycemia for up to 12 hours after drinking 3. do not ingest alone
Three exercise benefits for Diabetes
1. ⬆ insulin sensitivty 2. ⬇ risk for CAD a. ⬆ HDL, ⬇ triglycerides, ⬇ BP 3. Fosters weight reduction → delays/stops Type 2
What are 3 exercise recommendations?
1. should do low intensity aerobic (which ⬆ HR) 2. 20-40 minutes 3. 4-7 days a week
What are five Safe Exercise tips for Diabetics?
1. best time after a meal or snack (b/c BS is up) 2. check BS before and after (if < 100 → eat. if > 250 check ketones. If absent you're safe, if ketones are present do not exercise) 3. Carry fast acting sugar (ex. glucose tab, juice, hard candy) 4. drink water 5, Hypoglycemia can occur hours later
-slow intestinal absoprtion of carbs -stimulate insulin secretion -decrease cellular insulin resistant -enhance insulin action ** can be from multiple categories but not 2 from the same category. if you see that question the patient
What does insulin therapy do?
Mimics normal body insulin -daily dosing and intenstive therapy
What are 2 Oral Hypoglycemic Agents that ⬇ insulin resistance
What is an example of a Biguanides & what are the characteristics?
- ⬇ insulin resistance - can cause kidney damage - may be discontinued while in hospital - don't give if having a test containing dye - hold 48 hrs before & 48 hrs after test with dye. If ER then flush kidneys & then stop for 2 days afterwards - if dehydrated DON'T take → acute renal failure
- lowers basal & post meal glucose levels in pts w/ type 2 diabetes by reducing hepatic glucose production & tissue sensitivity to insulin
What is an example of a Thiazolidinediones (TDZ) & what are the characteristics?
What are 5 Nursing Implications for Insulin administration?
1. adjust dose on BS, carb (CHO) intake, illness, level of activity (patient usually aware of their carb intake) 2. absorption varies by site and activity of site (rotate sites → thighs, back of arms & abdomen) 3. hypoglycemia risk varies w/ type of insulin- must know OPD of each type 4. Mixing; clear-> cloudy. Do not mix glargine, detemir (long acting insulins) 5. usually held if pt. is NPO
What is Intensive Insulin Therapy/sliding scale insulin (2)?
1. Several doses of regular insulin given during the day based on BS levels - before meals & at bedtime (IV and injection in hospital, injections at home) 2. Insulin pump therapy
What is Insulin Sliding Scale (5)?
1. Insulin dose is adjusted to blood glucose levels 2. almost all hospitalized its (b/c stress of trauma) - Ex. infection, surgery, steroids → may cause patient to have to get insulin while hospitalized 3. usually before meals and HS when sleeping (ACHS bs) 4. scheduled (q6 hrs) when NPO 5. type of insulin specified- rapid or short acting NEVER intermediate or long acting
When is insulin usually checked when a patient is on a sliding scale (3)?
- before meals - at bedtime - q6 hours when NPO
What insulin's are NEVER given when a patient is on a sliding scale (2)?
Intermediate and Long Acting
What is Insulin Pump Therapy (8) & complications (3)?
1. continuous insulin 2. rapid/short acting insulin 3. catheter in abd. 4. basal rate (continuous/regular rate) and bolus - depending upon BS & what they ate 5. frequently check BS (4x per day) 6. change needle & site every 2-3 days 7. always worn 8. Most common w/Type 1
Complications: infection in site, hypoglycemia, hyperglycemia
Sick day management for a patient with diabetes (5)
- continue insulin (normally as possible) - follow meal plan = same times, drink fluids - check glucose & ketones more often - use OTC wisely (especially cough medicines b/c they contain glucose) - if on Metformin & they are N&V they should stop Metformin
what is prandial secretion?
it is insulin secreted at increased levels after eating
What is basal insulin secretion?
low levels of insulin that are secreted during fasting
What are four nursing diagnoses?
1. RC: Hyperglycemia 2. RC: Hypoglycemia 3. Risk for injury related to effects of hypoglycemia 4. Ineffective self-health management related to insufficient knowledge (you need to teach new diabetics)