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Diabetes Mellitus (Treatment (Insulin Regimen (Sliding Scale, Continuous…

- - - - hypoglycemia
        
        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
      - hyperglycemic hyperosmolar nonketotic syndrome
        
        T2D
        
        BS >34 mmol/L
        
        NO KETOACIDOSIS
        
        Treatment: same as DKA + more IV NS
      - diabetic ketoacidosis/diabetic coma
        
        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
    - - macrovascular disease: CAD, CVD, PVD
      - Microvascular disease: kidneys & eyes
      - neuropathic disease: involving nerves