Diabetes

• type 1 DM patho: typically triggered by autoimmune process (body hyper responds and attacks the beta cells), insulin producing beta cells of the pancreas are destroyed, absolute lack of insulin, and can be caused by pancreas resection
• clinical manifestations of type 1 DM: polyuria, polydipsia (thirsty), polyphagia ("starving" cells), fatigue, and weight loss
• medical management of type 1 DM: hemoglobin A1c, insulin, nutrition management, and patient education and self management
• type 1 DM complications: DKA, hypoglycemia, dawn phenomenon, and somogyi effect
• what is dawn phenomenon?

  early morning rise in blood glucose; normal response of body to raise blood glucose in the morning
• what is somogyi effect?

  the effect of hypoglycemia at night; at 3am pt is hypoglycemic and normal in the morning; adjust daytime insulin or eat before bed to treat it
• DKA S&S: kussmaul breathing (short in, long out; trying to blow off CO2) and glycosuria (lots of glucose in blood and urine)
• signs and symptoms due to lack of insulin: leads to increased blood glucose, polyuria, polydipsia, and polyphagia
• interventions for type 1 DM: vital signs (respiratory rate), I&Os, carbohydrate intake at meals, administer insulin as ordered, and administration of isotonic IV fluids as ordered
• labs for type 1 DM: potassium levels (insulin and glucose need potassium to cross the cell membrane) and bedside glucose monitoring
• why is potassium levels important for type 1 DM?

  if they are hypokalemic then they cant use insulin well
• teaching for type 1 DM: signs of hypo or hyperglycemia, subcutaneous insulin administration, medication education, regular blood glucose monitoring, healthy lifestyle and sick day care
• what must a type 1 diabetic do before being discharged from the hospital?

  check own blood glucose and give own insulin
• type 2 DM risk factors: BMI greater than 26, physical inactivity, HDL less than 35 (you want it higher than 50) and/or triglycerides greater than 250, metabolic syndrome, and pre diabetes
• patho of type 2 DM: cell membrane resists transport of glucose into cell, increased insulin required, pancreas beta cells fail
• type 2 DM clinical manifestations are the SAME as type 1 DM but slower onset
• medical treatment for type 2 DM: same as type 1 DM, but they can use oral antidiabetic agents also (metformin)
• metformin?


  increase cell sensitivity to insulin causing the liver to take up more glucose from the bloodstream and slowing down absorption of carbohydrates
• type 2 DM complications: hyperosmolar hyperglycemic state, depressed immune system (infections and poor wound healing), prolonged hyperglycemia, vascular effects, diabetic peripheral neuropathy, and autonomic neuropathy (visceral organs; aka silent heart attacks)
• DKA onset?


  rapid
• DKA occurrence?


  type 1 DM most often
• DKA lab work?


  BG greater than 250, pH less than 7.3, positive urine ketones
• HHS onset?


  gradual
• HHS occurence?


  older adults in response to stress or infection (type 2 DM)
• HHS lab work?


  BG greater than 600, pH greater than 7.4, negative urine ketones
• type 2 DM interventions: vital signs, self management, insulin or oral glucose control, capillary refill time, skin assessment, I&Os, administer oral diabetes medications as ordered, administer insulin as ordered, and administer isotonic IV fluids as ordered
• lab tests for type 2 DM: serum glucose, BG monitoring, HbA1c, urine for micoralbuminuria
• teaching for type 2 DM: medication education, regular blood glucose checks, healthy lifestyle, signs of hypo and hyperglycemia, foot care, monitoring for complications, diet
• infections RAISE blood glucose