blood admin/ diagonistic test/ diabtetes

• Hypoglycemia


  State of insufficient or low blood sugar levels < 70 mg/dl
• Causes of hypoglycemia


  • Insufficient nutrition
  • Adverse reaction to medication (sulfonylureas and beta blockers)
  • Increase exercise
  • Alcohol consumption
• Signs and symptoms of hypoglycemia

  • Irritability
  • Confusion
  • Shakiness
  • Unconscious
  • Fatigue
  • Coma/death
• Rule of 15


  Take blood sugar (low), give 15g of carbohydrate (candy, juice) wait 15 min and retake BG. Repeat until sugar is above 70 mg/dl
• Treatment for worsening/unconscious hypoglycemia

  1. Glucagon Im/ SQ- takes 20 mins to work

  2. IV D50 2w5-25 ml IV push
• Hyperglycemia


  State of elevated glucose > 100 mg/dl in fasting or <140 mg/dl in not fasting
• Causes of hyperglycemia


  • Insufficient insulin production
  • Deficient hormone signaling
  • Excessive counter regulatory hormone
• Types of diabetes mellitus

  • Prediabetes
  • Type 1
  • Type 1.5
  • Type 2
  • Type 3
  • MODY
  • Gestational (pregnancy)
  • Secondary diabetes- hormonal, disease induced,
• Types of glucose monitoring

  • Fasting glucose
  • Random glucose
  • Two Hour oral glucose tolerance test
  • Glycosylated hemoglobin A1C
• Fasting glucose


  Patient fasts for 8 hours and then gets finger stick. Range should be 70-100 mg/dl. 100-126= prediabetic
• Random glucose


  Patient is allowed to eat and then randomly gets BG stick >200 and s/s of polyuria, polyphagia, and polydipsia
• Two Hour oral glucose tolerance test


  Patient is brought in consumes a 75g drink and then blood is drawn at the 2 hr mark. >200= diabetic, 140-199= pre diabetes
• Glycosylated hemoglobin A1C


  Blood draw that allows blood sugars over the last 60-90 days to be seen. Normal range – 4-5.6% (less than 6%), Prediabetic- 5.6-6.6%
• Type 1.5 diabetes (Lada)


  Slow progressing of autoimmune diabetes, pancreas stops making insulin and destroys pancreatic cells, Often won't need insulin, Can be managed by exercise, diet, and weight control/ meds
• Type 3 diabetes


  Research shows Alzheimer's is more common in type 2 diabetics, Represents a form on diabetes that selectively involves brain
• MODY (maturity onset diabetes of the young)

  1. 5% of DM cases, Autosomal dominant, Leads to beta cell dysfunction, Occurs before 25 yo, Treatment depends on genetic mutation
• Prediabetes


  Beta cells become fatigued, HgbA1c 5.7-6.4%
• Type 1 diabetes


  Formerly known as "juvenile diabetes", "insulin dependent", Failure of the pancreas, May be genetic – recessive, Can be caused by toxins or virus, Environmental triggers, Risk increased with family members with autoimmune disorders, 5-10 % of all diabetics, Usually under age of 40, Peaks before 20 years of age, DKA complication
• Signs and symptoms of acute onset type 1 diabetes

  • Polydipsia- increase thirsty
  • Polyphagia- polyphagia
  • Polyuria increase urine
  • Weight loss
• Type 2 diabetes


  Formerly known as "Adult Onset", Most prevalent (90% of patients), Genetics – dominant and multifactorial, Insulin resistance, Highest among Native Americans and Hispanics followed by African Americans, Correlated with obesity, Usually over the age of 35, Also identified in young (especially with ↑ childhood obesity), Can result in HHNK (hyperosmolar nonketotic state)
• Signs and symptoms of type 2 diabetes


  • 3 Ps (Polydipsia, Polyphagia, Polyuria)
  • Fatigue
  • Slow healing wounds
  • Visual changes
• Modifiable risk factors for type 2 diabetes

  • BMI > 26
  • Smoking
  • Sedentary lifestyle
  • Metabolic syndrome
• Non-modifiable risk factors for type 2 diabetes

  • Gestational
  • Hypertension
  • Cardiac history
• Metabolic syndrome


  • Elevated insulin level
  • High triglycerides
  • Low HDL and high LDLs
  • HTN
  • Obesity
• Nutritional therapy for diabetes

  • Carbohydrates - Include fruits, vegetables whole grains and low-fat milk, Fiber intake 25-30 g/day
  • Protein - High protein diets for weight loss not recommended, 15-20% of daily intake
  • Fats - Eliminate trans fats, Less than 30% of daily intake
  • Alcohol - Limit to moderate amounts (1-2 drinks per day)
• Exercise for diabetes


  1. Monitor BS before, after, during

  2. Brisk walking
• Illness management for diabetes

  1. Eat regular diabetic diet

  2. Increase non-caloric fluids

  3. Continue with oral agents and/or insulin

  4. Monitor BS every 4 hrs

  5. If > 240 check urine for ketones and report

  6. If unable to keep any food or fluids down, notify physician immediately
• Decreased PO intake management for diabetes

  1. Supplement CHO food intake with CHO-containing fluids while continuing with oral agents and/or insulin

  2. Notify physician immediately if unable to keep any food or fluids down
• Somogyi effect


  Rebound effect of insulin overdose cause hyperglycemia in the morning. Decrease glucose at night and cause increase of compensatory mechanism and lead to high BS In the morning. Problem is hypoglycemia at night because of insulin given. Check BS btw 2-4 am
• Dawn phenomenon


  Hyperglycemia noted on awakening in AM due to release of hormone in predawn hours. Growth hormone level increase and glucose level increase, Increase insulin
• Diabetic ketoacidosis (DKA)


  Inadequate insulin for cells does not allow body to obtain energy and breakdown fat from liver and body. Caused by missed insulin
• Hyperosmolar hyperglycemic non ketotic state (HHNK)

  Produces enough insulin to prevent DKA, Not enough insulin to prevent diuresis, BS >400
• Treatment for DKA and HHNK

  1. IV NSS or 1/2 NSS

  2. Regular insulin IV

  3. When glucose falls + dextrose

  4. Bicarb for <7.10 pH

  5. Cardiac monitoring for hypokalemia
• Diagnostic studies


  • Arterial blood gases
  • D-dimer
  • Complete blood count (CBC)
  • Sputum
  • Biopsy
• Respiratory diagnostic imaging


  • CT scan
  • MRI
  • Chest X-ray
  • PET scan
• NPO for CT/ MRI/ PET due to aspiration risk and nausea from food + contrast
• Respiratory diagnostic tests

  • Pulmonary function studies/ peak flow
  • Ventilation/ perfusion
  • Bronchoscopy
  • Thoracentesis
• Serum biomarkers

  • Troponin
  • Homocysteine
  • High sensitivity C-reactive protein
  • Creatine kinases
• Troponin


  Released after myocardial injury, Levels are usually low
• Homocysteine


  Amino acid that when broken down into high levels leads to narrowing and hardening of blood vessels, Treat with vitamin B12/ folic acid/ vitamins