January 26, 2018 - become resistant to insulin. Type 1 Diabetes Vs...

Mark Klimek Lecture 5 January 26, 2018

Diabetes

Diabetes – you don’t metabolize your glucose right. Due to lack of insulin or cells become resistant to insulin.

Type 1 Diabetes Vs. Type 2 Diabetes • Type 1

• Insulin dependent
• Juvenile onset
• Ketosis Prone (makes ketones)

• Type 2

• Non insulin dependent
• Adult onset
• Non ketosis prone

• S/s

• Polyuria
• Polydipsia (increased thirst)
• Polyphagia (increased hunger)

Treatment • Type 1 – insulin, exercise, diet (in order of importance) • Type 2 – diet, oral hypoglycemic, activity (obesity reduction) can be treated with diet alone.

Diet Restrictions of type 2 diabetics • Calorie restrictions 1200-1800

• 6 small feedings/day Insulin – LOWERS the blood glucose.• Regular Insulin (humalin R, anything that ends in R)

• Onset – 1 hour
• Peak – 2 hours
• Duration – 4 hours
• Clear (solution) CAN BE IV drip
• Short rapid acting insulin (R stands for Rapid and Run)

• NPH – intermediate acting

• Onset – 6 hours
• Peak – 8-10 hours
• Duration – 12 hours
• Cloudy (suspension)
• N stands for Not so fast, Not in the bag (IV)

• Humolog, lispro – the most fastest acting insulin

• Onset – 15 minutes
• Peak – 30 minutes
• Duration – 3 hours
• GIVE with meals

• Lantus, Glargine – long acting insulin, so slow to absorb there is no esstential peak, they will not go hypoglycemic, only one you can give at bedtime

• Duration – 12 – 24 hours

• ALWAYS check the expiration date on all insulins before opening, if you open an insulin it expires 30 days after opening • Exercise potentiates (does the same thing) as insulin, if a diabetic is going to play soccer in the afternoon what should the nurse tell him to do? Take a carbohydrate snack to the game.• When a diabetic is sick their insulin needs are going to go up, they have increased glucose. Sick diabetic has two problems; hyperglycemia and dehydration.

Complications of Diabetes

Low blood glucose (hypoglycemic)

• Causes:

• Not enough food
• Too much insulin or medication (primary cause)
• Too much exercise

• Can cause brain damage

• S/S:

• “DRUNK IN SHOCK”
• Staggering gait
• Slurred speech
• Impaired judgement
• Delayed reaction time
• Labile emotion
• Hypotension
• Tachycardia
• Tachypnea
• Cool pale skin

• Treatment: rapidly metabolizable carbohydrate (sugar)

• ANY juice
• Candy
• Skim milk
• Honey
• Icing
• Jam

o Ideal combination of food: crackers and orange juice (sugar and starch),

apple juice and slice of turkey (sugar and protein) High blood glucosde (DKA) • Only type 1 can get DKA because they are ketosis prone and type 2 are nonketosis prone.

• Causes:

• Too much food
• Not enough medicaftion
• Not enough exercise

• Acute viral upper respiratory infections within the last two weeks is the

NUMBER 1 cause of DKA.

• S/S:

• Dehydration
• Ketones (blood, not urine), Kussmal (deep and rapid), High K+
• Acidotic (metabolic), Acetone breath, Anorexia due to nausea

• Treatment:

• Iv fluids fast 200ml/hr with regular insulin IV drip

• Higher priority over HHNK High blood sugar in type 2 (HHNK) • Hyperosmolar, hyperglycemic, non-ketotic coma (HHNK) • AKA dehydration • Hot, flushed, warm skin

• DX: fluid volume defecit

• Treatment: give fluids

• Outcomes: increased output, moist mucous membranes

• More life threatening than DKA Long term complications of diabetes • Renal failure • Foot gangrene • Peripheral neuropathy • Poor tissue perfusion Which lab test is best indicator of glucose control?• HA1C – glycosated hemoglobin, hemoglobin A1C • You want it to be less than or equal to <6 • >8 out of control • If they’re at 7 they’re on the border and they need some workup and evaluation.