Diabetes Mellitus
Treatment
Insulin Regimen
Sliding Scale
Continuous subcutaneous insuline infusion (CSII)
w/ meal bolus, BS before meals, carbohydrate counting
Compliications
acute
chronic
hypoglycemia
hyperglycemic hyperosmolar nonketotic syndrome
diabetic ketoacidosis/diabetic coma
macrovascular disease: CAD, CVD, PVD
Microvascular disease: kidneys & eyes
neuropathic disease: involving nerves
risk factors: >50% noctural, too much insulin or oral medication (relative to available glucose), not compensating: weight loss, menses, exercise, EtOH, decreased caloric intake
--> epinephrine and glucagon release
can also occur w/ sudden BG drop, though hyperglycemic (e.g. 14 to 8mmol0
treatment
mild-moderate: 15-20g of simple (fast-acting) carbohydrate:
3-4 glucose tablets
175 mL fruit juice/regular soft drink
6 Life saver candies
Nothing with fat!!
check BG in 15 mins
Snack: 1 protein, 1 starch
Recheck BG
Severe: 1mg glucagon (or D50W)
-pt wakes up-> oral starch snack
check BG in 15 min--OK--> Recheck BG in 2-3 hrs
mostly caused by underlying or concomitant infection (40%) - i.e. UTI, missed insulin (25%)
signs and symptoms
fruity breath
Kussmaul respiration - deep, brief, fast (to get rid of CO2 due to low pH in acidosis)
glucose in urine
diuresis, dehydration, electrolyte imbalance
leads to metabolic acidosis
GI symptoms
low blood sugar so fats used as energy source (fat --> glycerol --> glycogen --> glucose --> hyperglycemia), but produce KETONES as a by-product --> metabolic acidosis
Treatment
A: patent airway, intubate if obtunded
B: oxygen, as per MD order
C: IV NS until BP stable and urine output 30-60mL/hr
When BG approaches 12-14 mmol/L, switch to D5W. Avoid hypoglycemia
Fluid volume expanded? - correct fluid loss w/ 1/2 NS plus K+ (b/c decreases w/ insulin admin)
NPO
Insulin infusion: standard order - 0.1 units/kg/hr
Continue regimen for 36-48 hours
BG decrease rate: aim for <5 mmol/L/hr
WATCH OUT FOR CEREBRAL EDEMA R/T DKA
Neurological deterioration: headache, irritability, decreased LOA, decreased HR
assoc'd w/ bicarb administration, too rapid fluid and insulin treatment
T2D
BS >34 mmol/L
NO KETOACIDOSIS
Treatment: same as DKA + more IV NS