diabetes

• diabetes mellitus types


  DM1: lack of insulin

  DM2: insulin resistance
• diabetes mellitus symptoms


  polyuria, polydipsia, polyphagia
• diabetes insipidus and its symptoms

  diabetes w/o glucose affected

  • symptoms: polyuria, polydipsia leading to dehydration
• SIADH


  • opposite of diabetes insipidus
  • symptoms: oliguria, no thirst leading to fluid overload
  • decrease urine output
  • decrease serum/osmolality specific gravity
  • increase urine specific gravity
• retained urine and low specific gravity is...

  SIADH
• Fluid volume deficit is...

  DM, DI
• Fluid volume excess is...

  SIADH
• regular insulin

  • short acting
  • pattern: 1-2-4 (onset, peak, duration)
  • "RN's do it that way" --> regular (clear) before NPH (cloudy)
• NPH


  • intermediate acting
  • pattern: 6-8-10-12 (onset, peak, duration)
  • "RN's do it that way" --> regular (clear) before NPH (cloudy)
• LAG

  • fast acting
  • lispro, aspart, glulisine
  • pattern: 15-30-3 (onset [min], peak [min], duration [hours])
  • give with meal
• glargine/lantus


  • long acting
  • pattern: 12 to 24 (no onset or peak, only duration)
  • little to no risk of hypoglycemia
  • only insulin you can safely give at bedtime
• what does hypoglycemia look like?

  • think of drunk pt in shock
  • staggering gait, slurred speech, cerebral impairment, slow reaction time, decrease social inhibition
  • shock (vasomotor collapse): tachycardia, tachypnea, low BP, cold/clammy, mottled skin
• how to treat hypoglycemia

  • give sugar or rapidly metabolize carbohydrates
  • boards want sugar + starch/protein (ex: orange juice + crackers, apple juice + turkey, 1/2 cup skim milk bc milk is sugar/protein BUT NO normal milk bc we don't want the fat to convert to ketones)
• how not to treat hypoglycemia

  • candy + soda bc 1 sugar is fine, 2 sugars ARE BAD
  • 5 packs of sugar emptied into a glass of orange juice
• how to treat unconscious hypoglycemic pts

  • if pt is home: glucagon IM
  • if pt in ER: D10 or D50 IV (NOT D5 BC THAT'S ONLY 300 CALORIES)
• DKA causes


  • too much food
  • not enough insulin
  • not enough exercise
  • #1 cause: acute viral Upper Respiratory Infection w/i last 2 weeks --> hyperglycemic bc of stress due to illness
• S/Sx of DKA

  • "DKA"
  • Dehydration
  • Ketones (in serum), Kussmauls, high K+ (potassium)
  • Acidosis, Acetone breath (sweet breath), Anorexia due to nausea

  *ketones in blood/serum IS = DKA

  *ketones in urine DOES NOT = DKA
• DKA treatment

  • REGULAR insulin IV
  • IV fluid (fast rate at 200 mL/hr)
• DKA primarily affects DM1
• HHNK, HHS, or HHNS

  • hyperosmotic hyperglycemia nonketotic state (NONKETOTIC is hint that it affects DM2 bc type 1 is prone to ketones, NOT type 2)
  • HHNK = SEVERE DEHYDRATION
• HHNS causes


  • high blood sugar in DM2
• S/Sx of HHNS


  • DEHYDRATION
  • dry skin, flushed, decreased turgor, increased HR
• HHNS treatment


  • REHYDRATION!
  • outcomes of successful treatment: increase UO, moist mucous membranes
  • long-term complications: poor perfusion, peripheral neuropathy
• HHNS primarily affects DM2
• DKA pt is more dependent on insulin
• HHNS pt needs to be rehydrated
• long-term complications of diabetes

  • poor tissue perfusion
  • peripheral neuropathy
• what causes renal failure

  poor perfusion
• what causes gangrene

  poor perfusion
• what causes heart failure

  poor perfusion
• what causes urinary incontinence

  peripheral neuropathy
• what causes a pt to not feel a burn on the foot

  peripheral neuropathy
• 5 main meds for drug toxicities

  • lithium
  • lanoxin/digoxin
  • aminophylline,
  • phenytoin,
  • bilirubin