Diabetes

• Hypoglycemia


  Rapid fall in glucose levels
• Hypoglycemia symptoms from rapid glucose drop

  • Tachycardia
  • Palpitations
  • Cold and clammy
  • Nervousness
• Hypoglycemia symptoms from gradual glucose drop

  • Headache
  • Confusion
  • Drowsiness
  • Fatigue
• Persistent hypoglycemia can lead to irreversible brain damage, coma, convulsions, and death
• Hyperglycemia symptoms


  • Polydipsia
  • Polyuria
  • Polyphagia
  • Sweating
  • Weight loss
  • Irritability
• Signs of progressing hyperglycemia

  • Fruity breath
  • Acetone breath
  • Blurred vision
  • Dehydration
  • Kussmaul respiration
  • Low level of consciousness and coma
• Sulfonylureas


  Drug class that helps lower blood sugar levels in people with Type 2 diabetes by stimulating pancreatic beta cells to secrete more insulin, increasing tissue response to insulin, and decreasing glucose production
• Second generation sulfonylureas

  • Glipizide
  • Glyburide
  • Glimepiride. Advantages: increase insulin response, fewer interactions, longer duration, fewer side effects. Disadvantages: greater hypoglycemic potency, avoid with liver dysfunction
• Biguanides

  Drug class that lowers blood sugar levels in Type 2 diabetes by decreasing hepatic glucose production, diminishing glucose absorption, increasing insulin receptor sensitivity, and increasing peripheral glucose uptake, without stimulating insulin release
• Metformin


  Biguanide drug used to treat high blood sugar in Type 2 diabetes
• Metformin side effects


  • GI: anorexia, nausea, vomiting, diarrhea, flatulence, abdominal pain, weight loss
  • CNS: headache, weakness, decreased B12 levels, folic acid deficiency
  • Bitter or metallic taste
• Metformin can cause renal decline when given IV contrast, so it should be held for 48 hours
• Insulin pump


  • Only uses rapid-acting insulin
  • Provides basal rate and bolus for meals
  • Decreases risk of complications by keeping blood glucose close to normal
  • Requires frequent blood sugar monitoring and carb counting
  • Has alarms for missed doses or low/high levels
  • Tubing changed at recommended time
  • Alternate site every 72 hours
  • Risk of infection, check skin after removal
• Glucagon


  Given IM in emergencies if a patient is not alert enough to have oral glucose or if there is no IV, to raise blood sugar from a hypoglycemic coma
• Dextrose


  Given IV at 50% concentration to an unconscious hypoglycemic patient to raise blood sugar from a coma
• Diabetic ketoacidosis (DKA)


  • Dehydration
  • Hyperglycemia >500
  • Kussmaul respiration
  • Acidosis
  • Fruity breath
• DKA treatment


  1. IV insulin (with frequent glucose checks)

  2. IV fluids (.9 normal saline)

  3. Then switch to sliding scale