Level 2 - RNSG 1443 - Diabetes Complications

D.K.A. may result in a coma secondary to., - dehydration., electrolyte imbalance., & acid-osis

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If blood glucose is greater than 250 or less than 70 for 2 to 3 times in 1 week, the patient should call the doctor

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Type 1 diabetes seems to involve an interaction of genetic disposition with an environmental trigger, so the onset of symptoms is often abrupt, following an illness such as the flu.

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diabetics are more susceptible to infection like candida albicans and U.T.I's.

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hyp-O-glycemic unawareness., - is when a person does not experience the signs & symptoms of hyp-O-glycemia until levels are critically low. Often times the patient may be required to keep sugar levels a little higher., - for example: 150

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hyperglycemic hyperosmolar nonketotic syndrome (HHNS) primarily affects type 2 diabetics who are significantly dehydrated.

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normal A. 1 C. levels range from 4 to 6%., levels over 8% indicate poor glycemic control.

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polyphagia., - is increased appetite

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somogyi's phenomenon is the term for rebound morning hyperglycemia after night-time hyp-O-glycemia. it is often caused by too much insulin or the lack of an adequate bedtime snack

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the A. 1 C. goal for diabetics should be about 7

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the diagnosis of diabetes is based on 2 fasting blood glucose levels greater than 126

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what are the treatments for H.H.S?

0.45% or 0.9% Normal Saline., monitor electrolytes., Insulin., & when blood glucose reaches 250, add glucose

When treating D.K.A. or H.H.S., what steps are included?

1. I.V. fluids., 0.45% or 0.9% Normal Saline., 2. Electrolyte replacement with cardiac monitoring., 3. I.V. Insulin., & 4. if the blood glucose is greater than less than 250, add 5% or 10% glucose

what is the normal range for A. 1 C.?

5.7 to 6.4

early signs & Symptoms of hyperglycemia include., - Frequent urination., Increased thirst., Blurred vision., Fatigue., & Headache

late signs & Symptoms of hyperglycemia include., - Fruity-smelling breath., Nausea & vomiting., Shortness of breath., Dry mouth., Weakness., Confusion., Coma., & Abdominal pain

what does sensory neuropathy include?

loss of sensation., abnormal sensations., pain., & paresthesia.

what are the 2 types of angiopathy complications?

macrovascular., & microvascular

illness increases the risk for dehydration & hyperglycemia. continued administration of the regular dose of insulin & adequate fluid & carb intake are critical to prevent ketoacidosis.

monitor blood glucose levels every 4 hours & report persistent hyperglycemia, ketosis, nausea & vomiting, or other significant symptoms

what is the most common retinopathy?

non-proliferative

what are the 6 Ps of arterial thrombus assessment?

pain., pallor., paresthesia., poikilothermia., pulselessness., & paralysis

polyuria., - is increased urinary output

polydipsia., - is increased thirst

what are the classic symptoms of diabetes?

polyuria., polydipsia., & polyphagia

what are the signs & symptoms of hyperglycemia?

polyuria., polydipsia., polyphagia., fatigue., dry itchy skin., hunger., & nausea

non-proliferative retinopathy., - is the early stage of the disease in which the blood vessels in the retina are weakened. Tiny bulges in the blood vessels (called microaneurysms) may leak fluid into the retina. This leakage may lead to swelling of the macula

proliferative retinopathy., - is a developed form of retinopathy whereby new but weak blood vessels begin to form on the retina to help restore blood supply.

continuous I.V. infusions containing regular insulin are used to reduce the patient's blood glucose level.

regular insulin reduces blood glucose levels

what are the (2) types of neuropathy?

sensory., & autonomic

what are the signs & symptoms of hyp-O-glycemia?

shaking., fast heart rate., sweating., anxious., dizziness., hunger., headache., weakness, fatigue., impaired vision., & irritable

what happens if H.H.S. is left untreated?

somnolence, coma, seizures, hemiparesis, stroke.

symptoms of Hyp-O-glycemia include., - Confusion, heart palpitations, shakiness, and anxiety.

symptoms of Hyperglycemia include., - Increased thirst., Blurred vision., Frequent urination., Increased hunger., & Numbness or tingling in the feet.

diabetics with ketonuria & a blood glucose of 250 or above should avoid exercise.

symptoms of hyp-O-glycemia include disorientation, tremors, palpations, lightheadedness, confusion, cool, clammy skin, slurred speech, & lethargy.

what are the signs & symptoms of H.H.S?

tachycardia, kussmauls, hyp-O-tension, hyperglycemia. Blood Glucose greater than 600, & ketones negative

Selective serotonin & norepinephrine re-uptake inhibitors., - duloxetine : Cymbalta., - are anti-depressants that Increase levels of serotonin & norepinephrine, improving the body's ability to regulate pain., they Relieve neuropathic pain.

they Can cause nausea and vomiting, dizziness, dry mouth and headache.

Tricyclic anti-depressants., amitriptyline: Elavil., - Inhibit the re-uptake of norepinephrine & serotonin, which are neurotransmitters believed to play a role in transmission of pain through the spinal cord., they Relieve neuropathic pain.

they Can cause sedation, dry mouth and suicidal thoughts.

what are the Risk factors for hyperglycemia?

too much food., not enough insulin., stress., illness., & not enough exercise

there is no direct correlation, but family history is important in diabetes

women with gestational diabetes are at high risk for developing type 2 diabetes after pregnancy, but not all will get the disease.

what is included with microvascular angiopathy?

it can cause retinopathy, nephropathy, and neuropathy.

Charcot foot., - is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy).

Acanthosis nigricans is a skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened.

Diabetics are commonly on what heart med?

Ace inhibitors

Capsaicin (Zostrix)., - Depletes the accumulation of pain-mediating chemicals in the peripheral sensory neurons., they Relieve neuropathic pain.

Apply cream 3-4 times a day. Symptoms will increase at the start of therapy. Relief of pain is attained in 2-3 weeks.

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout your body. Diabetic neuropathy most often damages nerves in your legs and feet.

Symptoms include pain and numbness in the legs. In more severe cases, symptoms include issues with digestion, the bladder, and controlling heart rate.

sensory neuropathy., aka Peripheral neuropathy., - is Weakness, numbness, and pain from nerve damage, usually in the hands and feet.

Symptoms include pain, a pins-and-needles sensation, numbness, and weakness.

Hyperosmolar Hyperglycemic State., or H.H.S., - is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.

Symptoms of H.H.S. include., - signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness

To compensate for ketoacidosis (metabolic acidosis) the lungs attempt to remove carbon dioxide through a pattern of deep, rapid respirations called Kussmaul respirations

ketoacidosis = metabolic acid-osis which = Kussmaul respirations

Antiseizure., gabapentin (Neurontin)., pregabalin (Lyrica)., - Decreases the release of neurotransmitters that transmit pain., they Relieve neuropathic pain.

Can cause dizziness, somnolence and peripheral edema.

Treatment for of H.H.S., is I.V. saline solution and insulin.

Complications of H.H.S. include., - coma, seizures, and death.

Confusion, heart palpitations, shakiness, and anxiety are symptoms of Hyp-O-glycemia.

Consuming high-sugar foods or drinks, such as orange juice or regular soda, can treat Hyp-O-glycemia. Alternatively, medications can be used to raise blood sugar levels.

what is included with macrovascular angiopathy?

Coronary artery disease (CAD), Peripheral vascular disease (PVD), hypertension (HTN), stroke (CVA), & heart attack (MI).

Diabetic Ketoacidosis., or D.K.A., - A serious diabetes complication where the body produces excess blood acids (ketones).

D.K.A, occurs when there isn't enough insulin in the body. It can be triggered by infection or other illness.

what do these lab findings indicate? Blood Glucose greater than 250, (ABG) metabolic acid-osis., & ketones

D.K.A.

H.H.S., - develops over a longer period of time., may result in greater fluid loss., & has minimal to No ketonuria

D.K.A., - develops rapidly., & there are ketones in the urine

Hyp-O-glycemia., - is Low blood sugar, the body's main energy source.

Diabetes treatment & other conditions can cause hyp-O-glycemia.

Diabetic retinopathy., - is a diabetes complication that affects the eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).

Diabetic nephropathy , also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes

Hyperglycemia., - is a defining characteristic of diabetes., — when the blood glucose level is too high because the body isn't properly using or doesn't make the hormone insulin.

Eating too many processed foods may also cause your blood sugar to rise.

Necrobiosis lipoidica diabeticorum is an uncommon skin condition related to diabetes. It results in reddish brown areas of the skin, most commonly on the lower legs

Granuloma annulare is a chronic skin condition that causes raised reddish or skin-colored bumps (lesions) in a ring pattern, usually on the hands and feet.

D.K.A. = Diabetic ketoacidosis

H.H.S. = hyperosmolar hyperglycemic syndrome

Symptoms of D.K.A. include., - thirst, frequent urination, nausea, abdominal pain, weakness, fruity-scented breath, and confusion.

Hospital treatment to replace fluids and electrolytes and provide insulin therapy may be needed for D.K.A.

what are the treatments for D.K.A.?

I.V. fluids, 0.45% or 0.9% Normal Saline., electrolyte replacement (K+)., Insulin I.V., ensure airway., & administer oxygen

Macrovascular complications is caused by hyperglycemia, & include., - cardiovascular diseases such as heart attacks, strokes and insufficiency in blood flow to legs.

Microvascular complications is caused by hyperglycemia, & include., - damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure & to nerves (neuropathy) leading to impotence & diabetic foot disorders (which include severe infections leading to amputation).

angiopathy., - is damage to blood vessels. & is the leading cause of diabetes-related deaths.

Peripheral artery disease (PAD)., - decreases blood flow and delays healing

what are the treatments for hyp-O-glycemia?

Rule of 15., if blood glucose is less than 70, Give 15g of simple carbs., wait 15 minutes, & recheck., repeat 2 to 3 times as needed.

gastroparesis., - is A condition that affects the stomach muscles and prevents proper stomach emptying.

Symptoms include nausea and a full feeling after little food is eaten.

the treatment for hyperglycemia includes fluid replacement to correct dehydration caused by the increased concentration of glucose in the blood.

isotonic fluids such as normal saline, are used initially to treat the dehydration

The sulfonylureas, such as glyburide., stimulate the production and release of insulin from the pancreas.

To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary arteriogram & should not be used for 48 hours after I.V. contrast media are administered.

Ace inhibitors., lisinopril., & angiotensin 2 receptor antagonists., losartan., - Delay progression of neuropathy in patients with diabetes., & treats hypertension

Watch for hyp-O-tension. Blood glucose must be tightly controlled in patients with diabetic neuropathy.

feeling shaky & sweaty are symptoms of hyp-O-glycemia.

alcohol contains empty calories & is also likely to cause blood glucose to decrease.

Hyp-O-glycemic unawareness., - the patient is unaware of a deep drop in blood sugar because it fails to trigger the secretion of epinephrine which generates the characteristic symptoms of hyp-O-glycemia

angiopathy., - is a disease of the blood vessels associated with diabetic complications

how often should patients with diabetes have an eye exam by an ophthalmologist with dilation?

annually

sensory neuropathy., - effects the peripheral nervous system.

autonomic neuropathy., - effects many systems.

what are complications of diabetes?

burning sensation in toes., protein in urine., a sore that is having trouble healing.

what are the signs & symptoms of D.K.A.?

dehydration with dry mucous membranes., tachycardia and/or hyp-O-tension., kussmaul respirations and/or acetone breath

what do intergumentary complications include?

dermopathy and acanthosis nigricans

exercise may cause hyp-O-glycemia during or after the activity., therefore, additional carbs may be needed before, during, or after exercise.

exercise in patients with uncontrolled diabetes results in hyperglycemia & may lead to ketosis.

what are the treatments for hyperglycemia?

exercise., drink water., & eat less carbs at next meal

in treatment of hyp-O-glycemia, once blood glucose is greater than 70, give a complex carb.

for example: peanut butter & crackers.

in addition to monitoring the blood glucose level, what additional lab values should the nurse monitor carefully?

hemoglobin., calcium., potassium., & BUN

what does autonomic neuropathy include?

hyp-o-glycemic unawareness., bowel incontinence., urinary retention., gastroparesis., cardiovascular abnormalities., & Erectile Dysfunction.

hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) is caused by persistent hyperglycemia, but ketosis does not occur. there is enough insulin present to prevent breakdown of fats which leads to ketosis., therefore, ketones are not found in the urine.

hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is caused by persistent hyperglycemia resulting in osmotic diuresis, which results in fluid & electrolyte losses.

if the patient is not awake, & are not in the hospital., - give glucagon intramuscular injection or sub Q., watch out for rebound hyp-O-glycemia.

if not awake, & are in hospoital., - give 50% dextrose I.V. push