January 26, 2020 - become resistant to insulin. Type 1 Diabetes Vs...

Mark Klimek Lecture 5 January 26, 2020 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