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Chapter 37 Care of Patients With Diabetes and Hypoglycemia
Terms in this set (38)
IDDM- Insulin dependent diabetes mellitus
Type 1 Diabetes Mellitus
Immune system destroys beta cells in pancreas that make insulin.
Diabetic ketoacidosis ( DKA ) symptoms
Dry, Hot skin, Fruity breath, Kussmaul's respiration's, and abdominal pain
Gestational Diabetes Mellitus
20-50% changes of developing diabetes within 5-10 years.
5-10% of women will be diagnosed with DM II after delivery
Latent Autoimmune Diabetes ( LADA )
Slow onset type 1 diabetes or type 1.5 diabetes
Islet cell antibodies will destroy beta cells
Diagnosed by: Onset after age 30, islet cell antibodies in blood.
Development of Type 2 Diabetes
Obesity, Family history, Physical inactivity
Most effected ethnicity
Symptoms of Type 1 Diabetes
Polydipsia, Polyuria, Polyphagia
Rapid loss of weight
Diaphoresis with cool, clammy skin
Symptoms of Type 2 Diabetes
Poor healing of scratches, Blurred vision, Itching, Drowsiness
Polydipsia, Polyuria, and Polyphagia
Leads to cellular dehydration
Fatigue, muscle weakness, and weight loss in Type 1 diabetes occurs d/t what?
Absence of insulin to metabolize protein and fats broken down then fatty acids are converted to Keton bodies ( DKA ). Which leads to fatal acidosis
Drop in hemoglobin A1c level indicates
Better blood glucose control within last 1-3 months.
Elderly prone to severe hypoglycemia
Tight control may NOT be the best thing for the elderly adult due to being prone more to CAD problems
Home emergency supplies for acute hypoglycemic reactions.
OJ, hard candy, sugar cubes, honey, skim milk
LOC use glucagon injection 1mg.
Before intense exercise: Swimming
Eat 15-20gm complex carbs with protein
Actos (Pioglitazone) is contraindicated
In patients with CHF
Sulfonylureas are from the same family of drugs as the sulfonamide antibiotics, use caution in persons known to have an allergy to sulfa drugs such as
Rapid acting insulin
Which insulin should never be mixed?
Insulin sliding scale: <70
Give OJ and notify MD
Insulin sliding scale: 71-150
Give 0 units
Insulin sliding scale: 150-200
Give 2 units
Insulin sliding scale: 201-250
Give 4 units
Insulin sliding scale: 251-300
Give 6 units
Insulin sliding scale: 301-350
Give 8 units
Insulin sliding scale: 351-400
Give 10 units
Insulin sliding scale: >400
Give 12 units and notify MD
Always draw CLEAR (fast-acting) insulin before CLOUDY
Every insulin dose MUST be verified by another nurse as it is drawn up, EVERY TIME!!!!
Must call physician to get order to hold Glucophage (OHA)
If heart cath with elevated BUN and creatinine.
Diabetic ketoacidosis (DKA)
Incomplete metabolism of fats d/t insufficient insulin, leaving byproducts called ketones.
Reinforce sick days to encourage compliance
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS type II)
High blood osmolality; 600-1000 Severe dehydration
(HHNS type II) Treatment:
Fluid replacement, correction of electrolyte imbalances
D5 1/2 NS, insulin gtt, and k-dur 40mg
Somogyi effect- After a hypoglycemic episode, then will become hyperglycemia due to increased circulating hormones.
Hyperglycemia in morning d/t growth hormone
Cardiovascular disease (CAD)
Patient Teaching Foot Care:
*Inspect daily for cuts, cracks, blisters
*Wash with warm water only
*Dry thoroughly between toes and do NOT use lotion between toes.
*Cut nails straight across
*Wear clean cotton socks everyday
*Don't wear sandals or open toe shoes
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