Exam (elaborations) NR 325

• Diabetes- 15 q’s: what is type 1 (no insulin- need insulin for the rest of their life) • Type 2- producing little or not enough (what is being produced, is not being used) or no insulin (95% of all diabetes is type 2) know the distinction • Diabetes pt- sugar sitting in their blood, (infection) risk factor for developing dm- obesity, AA, sedentary lifestyle, high BP, high cholesterol, nutrition (can all predispose you to diabetes) • Labs to track diabetes- hemoglobin A1C less than 6.5%; fasting blood sugar • Review all complications for diabetes: hypoglycemia (know all the symptoms), DKA, neuropathy—has to do with amputation, retinopathy, nephropathy- it will destroy kidney over time— someone with diabetes you better be checking their labs--know all labs (BUN, creat, gfr, CBC) • How to correct hypoglycemia- (rule of 15) 15g carbs, repeat sugar in 15 min, is still low give another 15 g of carbs if they are non-responsive the medication that you give is dextrose 50%, or give glucagon injection (only give one of them) • Control diabetes from the side of weight loss, exercise and nutrition • You can actually manage type 2 diabetes with weight loss, exercise, nutrition—it is so essential • With type 1 diabetes they need insulin • Type 2 we give them oral hypoglycemic agent—they may also need insulin • When diabetics are sick you will have to increase their insulin dosage because your body produces stress hormones (steroids- will also make your blood sugar higher) • That’s why when pt are sick like (pneumonia, uti and such, their blood sugar will go up like crazy) you better anticipate on increasing their insulin dosage • For type 2 you have to anticipate that you will be giving them insulin even if they are taking tablet at home • Steroid will cause diabetes to worsen (will cause sugar to go up)- adenosterone adrenocortical steroid • Diabetes cause high BP/cholesterol and damage to blood vessels, poor circulation that’s why they have a problem with their feet—need to take care of their feet (amputation— have to check their feet daily) wounds will not heal quickly • Pts who tend to have complications from diabetes are pts with pregnancy yeast infection diabetes will cause; poor wound healing/delayed • Diabetes will cause infections/ yeast infections esp pregnant women • DKA associated with type 1 : they are diabetic and they are acidotic, fruity breath because of the ketones (you open the door in their room it will be smelling like nice flowers) • DKA treatment: aggressive hydration and regular insulin, IV- sodium bicarb IV—we start titraing their blood sugar to be coming down when giving regular insulin, once you reach 250, you add dextrose to the IV to titrate –because you don’t want them to develop hypoglycemia • When someone had DKA correct with regular insulin, that’s why they have DKA and ketones- correct the underlying problem, get their blood sugar .............................................CONTINUED........................