Please enable JavaScript.

Coggle requires JavaScript to display documents.

Diabetes- a chronic multisystem disease characterized by hyperglycemia…

- - - - tissues do not respond to action of insulin b/c insulin receptors are unresponsive or insufficient in #
    - - compensatory overproduction of insulin or when B-cell mass is lost
    - - does not properly regulate release of glucose in response to blood levels
    - - play a role in glucose and fat metabolism
- - - - symptoms
        
        elevated blood glucose
        
        incr. urination
        
        incr. appetite followed by lack of appetite
        
        weakness, fatigue
        
        blurred vision
        
        headache
        
        glycosuria
        
        nausea and vomiting
        
        abdominal cramps
        
        mood swings
      - causes
        
        illness, infection
        
        corticosteroids
        
        too much food
        
        too little or no meds
        
        inactivity
        
        emotional, physical stress
        
        poor absorption of insulin
      - more gradual onset
      - treatment
        
        diabetes med
        
        check blood glucose frequently and check urine ketones
        
        brink fluids at least on hourly basis
        
        contact HCP about ketonuria
      - prevention
        
        med adherence
        
        healthy food choices
        
        check BG every 4 hours when sick
        
        routine BG monitoring
        
        diabetes identification band
      - Complications
        
        Diabetes Ketoacidosis (DKA)
        
        characterized by hyperglycemia, ketosis, acidosis, and dehydration
        
        Risk factors
        
        illness
        
        infection
        
        inadequate med dose
        
        undiagnosed diabetes
        
        More common in type 1
        
        symptoms
        
        dehydration
        
        poor skin turgor
        
        dry mucous membranes
        
        tachycardia
        
        orthostatic hypotension
        
        weak and rapid pulse
        
        vomiting
        
        Kussmaul respirations
        
        deep, rapid, and labored breathing
        
        sweet fruity acetone breath
        
        Diagnostics
        
        BG levels > 250mg/dL (13.9mmol/L)
        
        ABG
        
        pH<7.30
        
        serum HCO3 < 16 mEq/L
        
        moderate to large amount of ketones found in urine
        
        Complications
        
        death if left untreated
        
        Hyperosmolar Hyperglycemia Syndrome (HHS)
        
        life threatening; occurs in DM pts able to make enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion
        
        symptoms
        
        fewer symptoms than DKA so BG levels can rise quite high before noted
        
        incr. serum osmolarity
        
        somnolence
        
        coma
        
        seizures
        
        hemiparesis
        
        aphasia
        
        less common than DKA
        
        risks
        
        UTIs
        
        pneumonia
        
        sepsis
        
        any acute illness
        
        more common in newly diagnosed type 2
        
        diagnostics
        
        BG >600mg/dL (33.33 mmol/L)
        
        marked incr. serum osmolarity
        
        ketone bodies absent or minimal
        
        complications
        
        shock
        
        blood clot
        
        death
        
        cerebral edema
    - - symptoms
        
        blood glucose <70mg/dL (3.9mmol/L)
        
        cold, clammy skin
        
        numbness of fingers, toes, mouth
        
        tachycardia
        
        emotional changes
        
        headache
        
        anxiety/nervousness/ tremors
        
        faintness, dizziness
        
        unsteady gait, slurred speech
        
        hunger
        
        changes in vision
        
        diaphoresis (sweating)
      - causes
        
        alcohol intake without food
        
        too little food
        
        too much med
        
        too much exercise
        
        med or food at wrong time
        
        loss of weight w/o med change
        
        B-adrenergic blocker use interferes with recognition of symptoms
      - rapid onset; pattern of sxs changes over time
      - treatment
        
        Rule of 15: 15 g carbs, recheck glucose after 15 min. if value still < 70mg/dL continue every 15 min until above
        
        no improvement after 2 or 3 doses: contact HCP
        
        worsening or unconscious: subQ or IM injection of 1mg glucagon or IV of 25-50ml of 50% glucose
      - Prevention
        
        med adherence
        
        coordinate med dose with eating
        
        eat adequate food intake for calories and exercise
        
        recognize sxs and treat immediately
        
        carry simple carbs
        
        family/caregiver teaching about sxs and treatment
        
        check BG routinely
        
        diabetes identification bracelet
      - complications
        
        untreated
        
        coma, death, seizure
  - - - Macrovascular
        
        disease of large and medium blood vessels that occur with greater frequency and an earlier onset in people with diabetes
        
        RIsk factors
        
        obesity
        
        smoking
        
        hypertension
        
        high fat intake
        
        sedentary lifestyle
      - Microvascular
        
        result from thickening of the vessel membranes in the capillaries and arterioles (small vessels) in response to chronic hyperglycemia
        
        retinopathy
        
        most common cause of adult blindness
        
        nonproliferative
        
        most common; partial occlusion of the small blood vessels in the retina causes micro-aneurysms to develop in capillary walls
        
        capillary fluid leaks causing retinal edema
        
        eventually hard exudates intraretinal hemorrhages
        
        1 more item...
        
        proliferative
        
        more severe and involves the retina and vitreous
        
        when retinal capillaries are occluded, new, fragile blood vessels form
        
        eventually light does not reach retina as vessels break and bleed
        
        1 more item...
        
        laser photocoagulation
        
        nephropathy
        
        damage to the small blood vessels that supply the glomeruli of the kidney
        
        leading cause of end-stage renal disease
        
        Risk factors
        
        hypertension
        
        uncontrolled BG
        
        Diagnostics
        
        serum creatine measured to give an estimate GFR and degree of renal function
        
        diabetics screened annually to assess for albuminuria and to measure albumin to creatine ratio
        
        neuropathy
        
        nerve damage that occurs b/c of metabolic alterations associated with diabetes
        
        60-70% diabetes pts
        
        60% of nontraumatic amputations in US
        
        sensory
        
        most common
        
        affects peripheral NS
        
        most common is distal symmetric which affects hands and feet
        
        symptoms
        
        loss of sensation
        
        abnormal sensations
        
        pain
        
        1 more item...
        
        paresthesias
        
        1 more item...
        
        autonomic
        
        all body systems
        
        can lead to hypoglycemia unawareness, bowel incontinence and diarrhea, and urinary retention
        
        delayed gastric emptying (gastroparesis)
        
        symptoms
        
        vomiting
        
        GE reflux
        
        feelings of fullness
        
        nausea
        
        cardiovascular abnormalities
        
        postural hypotension
        
        painless Myocardial infarction
        
        resting tachycardia
        
        Erectile Dysfunction
- - - - assess injection site for lipodystrophy or other reaction
    - - assess pt mental status, eating habits, home environment, attitude towards diabetes, ad medication history