Diabetes

• diagnostic lab values

  normal glucose: 74-106 mg/dL

  A1C: 6.5% or higher

  FPG: 126 mg/dL or higher

  2-hour plasma glucose (75g load): 200 mg/dL or higher
• hypoglycemia s/s

  cold clammy skin, numbness, tachycardia, emotional changes, headache, nervousness, tremors, dizziness, unsteady gait, slurred speech, hunger, vision changes, seizures, coma
• hyperglycemia s/s

  increased urination / appetite, weakness, fatigue, blurred vision, headache, glucosuria, nausea / vomiting, abdominal cramps, mood swings
• nursing interventions & teaching

  self-monitoring, medication administration, diet, avoid alcohol, hygiene, exercise
• assessments

  history, physical assessment, blood tests, urinalysis, BP, ECG, dental exam, neurologic exam, foot exam, weight monitoring
• DKA interventions

  initial: ensure airway, give O2, establish IV, give 0.9NS until BP stabilized and urine output 30-60 mL/hour, begin insulin drip

  ongoing: monitor vitals, LOC, ECG, O2, urine output, breath sounds, glucose, potassium, sodium bicarbonate for severe acidosis
• DKA treatment

  manage airway, correct fluid / electrolyte imbalance first with IV infusion 0.45 or 0.9 to restore urine output and raise BP

  as BG approaches 250... D5W (prevent hypoglycemia)

  potassium replacement (monitor as IV insulin can worsen hypokalemia)
• chronic complications - elevated BG

  stroke, hypertension, dermopathy, atherosclerosis, nephropathy, neuropathy, neurogenic bladder, retinopathy, CAD, gastroparesis, infections