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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 oInsulin dependent oJuvenile onset oKetosis Prone (makes ketones) Type 2 oNon insulin dependent oAdult onset oNon ketosis prone S/s oPolyuria oPolydipsia (increased thirst) oPolyphagia (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 This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:39:24 GMT -05:00
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6 small feedings/day Insulin – LOWERS the blood glucose.Regular Insulin (humalin R, anything that ends in R) oOnset – 1 hour oPeak – 2 hours oDuration – 4 hours oClear (solution) CAN BE IV drip oShort rapid acting insulin (R stands for Rapid and Run) NPH – intermediate acting oOnset – 6 hours oPeak – 8-10 hours oDuration – 12 hours oCloudy (suspension) oN stands for Not so fast, Not in the bag (IV) Humolog, lispro – the most fastest acting insulin oOnset – 15 minutes oPeak – 30 minutes oDuration – 3 hours oGIVE 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 oDuration – 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. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:39:24 GMT -05:00
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Complications of Diabetes Low blood glucose (hypoglycemic)
Causes:
oNot enough food oToo much insulin or medication (primary cause) oToo much exercise Can cause brain damage
S/S:
o“DRUNK IN SHOCK” oStaggering gait oSlurred speech oImpaired judgement oDelayed reaction time oLabile emotion oHypotension oTachycardia oTachypnea oCool pale skin
Treatment: rapidly metabolizable carbohydrate (sugar)
oANY juice oCandy oSkim milk oHoney oIcing oJam
oIdeal 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:
oToo much food oNot enough medicaftion oNot enough exercise This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:39:24 GMT -05:00
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oAcute viral upper respiratory infections within the last two weeks is the NUMBER 1 cause of DKA.
S/S:
oDehydration oKetones (blood, not urine), Kussmal (deep and rapid), High K+ oAcidotic (metabolic), Acetone breath, Anorexia due to nausea
Treatment:
oIv 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. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:39:24 GMT -05:00
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