NURS 330 Week 1 Lecture (Exam 1)

• Euglycemic levels while fasting range from 60-110 mg/dL
• If glucose levels are high, then beta cells release insulin to lower it
• If glucose levels are low, then alpha cells release glucagon to raise it
• Glycogenesis is the process of forming glycogen from glucose.
• Glycogenolysis is the breakdown of glycogen into glucose
• Gluconeogenesis is the process of converting non-carbohydrate molecules or protein into glucose
• The brain needs glucose, as it cannot store it, there must be some in the blood
• If there is no insulin available, a build up of glucose in the blood called hyperglycemia will occur
• Diabetes Mellitus is a common, chronic, complex disorder of impaired nutrient metabolism
• Diabetes Mellitus is an end organ disease that results from a lack of insulin production or insulin resistance
• Type 1 Diabetes occurs when no insulin is produced, often due to beta cell destruction by autoimmune system
• Type 2 Diabetes occurs when insulin resistance is developed, but some insulin can be produced
• MODY is an inherited mutation that prevents insulin function
• Gestational Diabetes is glucose intolerance while pregnant
• Glycosuria is the presence of glucose in the urine from passing the renal threshold
• Polyuria is the excessive production of urine. It is due to large molecules of glucose spilling out and pulling fluid
• Polydipsia is excessive thirst to make up for the fluid loss
• Polyphagia is excessive hunger due to the catabolic state of the body
• Ketogenesis is the process of producing ketone bodies from fatty acids.
• Polyuria leads to dehydration with diabetes. This leads to hemoconcentration, hypovolemia, hypoxia, and low perforation
• Without insulin, the body can become acidotic
• Diabetic Ketoacidosis (DKA) is when glucose is greater then 300, ketones are found in the urine, and pH is less than 7.35
• DKA S&Sx include Kussmal's Respirations, fruity breath, nausea, abdominal pain, the 3Ps, weight loss, dry skin, sunken eyes, lethargy, and coma
• Anion gap is Na - (Cl + HCO3)
• The higher the anion gap, the sicker the patient is
• In DKA, treat dehydration, potassium level, anion gap, and address triggers
• Potassium levels drop with DKA and require continuous heart monitoring and IV K+
• Have patient check glucose Q4-6 hours, check urine for ketones, prevent dehydration, and eat enough
• Hyperglycemic-Hyperosmolar State (HHS) is when glucose is greater than 600, without ketones, and pH is greater than 7.3
• HHS S&SX include AMS, and those of DKA
• Factors contributing to HHS include MI, sepsis, and pancreatitis
• Treat HHS with fluid replacement and then check blood pressure to determine type of saline given
• Hypoglycemia is when the blood glucose level is too low. It is 70 for some, while 30 for others
• Hypoglycemia S&Sx include skin cool and clammy, anxiety, seizures, confusion, coma, blurry vision, increased HR, fatigue
• Hypoglycemia causes include wrong insulin, wrong dose, wrong time, plus gastric empty decrease and decreased intake
• If low glucose, follow 15/15/15 rule and give 15g CHO, check in 15 minutes, and then more CHO if low
• With 15/15/15, if patient cannot swallow then give them SQ glucagon or IV dextrose (if good IV)
• Macrovascular leads to poor perfusion and a risk for heart disease, CVD, PVD, stroke, and heart attack
• Nephropathy is the inflammation of the kidney.
• For nephropathy prevention, normalize BP with ACE or ARB