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ACUTE COMPLICATION (HYPOGLYCEMIC (not enough sugar in blood to feed cell),…

- - - - unplanned events/change of plans can cause hypoglycemia
  - - - 15 grams of carbs and liquid FIRST
        
        if not over 70 in 15 minutes, give 30 grams of carbs
        
        check in 15 mins, call doc. if not increased
        
        if normal - recheck in 60 minutes
      - contraindications
        
        NPO
        
        glucose gel
        
        actively vomiting
    - - glucagon
        
        isnt immediate acting - hormone injection
        
        used in long term settings so pt doesnt need IV
        
        vomiting is a big concern
        
        turn on their side and elevate head of bed
      - dextrose
        
        D50 (IV push)
        
        give in a large artery - vein will blow
        
        25 mg of sugar
        
        hypertonic fluid - can cause tissue damage, fluid shift, etc.
      - used when pt can't follow directions, NPO, nonresponsive
  - - - 15 min thing
- - - - higher risk of dehydration
  - - - a lot of pull of fluid from tissues
        
        dehydration
  - - - diet
      - exercise
      - lifestyle
      - how to reduce risk of infection
  - - - get BP normal
    - - start IV insulin after IV fluids
        
        start at 0.15 units/kg
        
        hypokalemia
    - - check every hour to 2 hrs
    - - may need surgery, or NPO (pancreatitis)
- - - - low BP
      - dry mucous membranes
  - - - NPO status - dont want more sugar in the body
        
        DOC decides when status can be lifted
      - 15-20 mL/kg/hr
        
        assess for FVE
      - glucose below 250 - change to 1/2NS at 4-14mL/kg/hr
        
        asses for FVE
      - helps with acidosis
    - - sodium bicarbonate given when pH is below 7.2
      - fluids for rehydration
    - - IV insulin (reg insulin)
        
        dont want to decrease to quickly - cause damage to CNS
        
        insulin drip will have protocol
        
        started at around 0.1 unit/kg
        
        titrate based on value
        
        hypokalemia
    - - K+ rider or added in fluids
      - BNP shows K+ less than 5 - itll keep dropping as we give insulin
      - HAVE TO HAVE URINE OUTPUT - risk for hyperkalemia
        
        ask when last time urinated
        
        when was last wet diaper (babies)