African American/Hispanics more at risk for getting diabetes
-
Type 1: dependent – for life insulin
Type 2: resistant – older age
Obesity: #1 risk factor for diabetes
A1c is good for hyperglycemia
Brain cellularly works with glucose
- Brain needs carbs for fuel
If you don’t eat, breaks down protein and fat
Byproduct of fat metabolism
- Ketones
Exclusively burning fat and you aren’t breaking down carbs
- Type 1 diabetes affected most by ketoacidosis
Anybody with diabetes can be ketonic
If you start to damage blood supply to the kidney, you go into acute renal dysfunction
- Any place in the body that doesn’t perfuse leads to amputation
- Lower limbs more commonly affected
Neuropathy
- Hot things are discouraged for normal sensation
- Not able to feel injury, may get worse
HgBA1c
- Prediabetic depends on this factor
Adrenal gland tumor
- High BP
- High cortisol levels
Too much cortisone= high BP
Prednisone
- Blood sugar is going to increase
Hypoglycemia
- Fatigue
- Lethargic
- Shaky
- Headache
- Syncope
- Neuro status is important
Hyperglycemia with ketones is DKA
- Mgmt. is different
- The ketones make it different
Pancreas isn’t working appropriately
- Glucose
Fasting <100
- Take glucose before meals
After you eat: 180
Before bedtime
- Glucose levels rise
A1c: less than or around 7
A1c for diabetes: 5.6
Fasting glucose is elevated
2 hr plasma glucose
- Draw it, give them a drink and they stick it at 1 and 2 hours
- Goal: do not want to exceed 199
- More with type 2 diabetics
Type 1: REQUIRES INSULIN
- Fast onset
Type 2: progressive, a little at a time
- Metformin
- Oral hypoglycemic drugs to start, initially may need to convert to insulin or use both
Hyperlipidemia, hypercholesteremia, all of it leads to diabetes
Type 1’s lose weight because everything is being peed out
- They don’t have insulin to manage the food
Type 1 have a lot of neuro changes and severe weight loss
Diabetics should wear a bracelet
- People on insulin they recommend a bracelet
D5W: diabetics
Bolus: NS
Push D50 if someone is unresponsive and hypoglycemic
Or glucagon IM if patient doesn’t have an IV site
A1c tests for the last 3 months
HHS:
Clinical manifestations: dehydration, hypotension, tachy, decreased LOC (seizures)
Patho: complication of DM. occurs when a blood sugar is topo high for a long period of time
leading to severe dehydration.
Treatment:
Diagnostics: a plasma glucose level >600 mg/dL
increased effective plasma osmolality >320 mOsm/kg in the absence of ketoacidosis.
- Plasma osmolarity ranging from 300 to 320 mosm/mL
A very high blood sugar level (over 600 mg/dL) with low ketone levels (acids in
blood and urine) will help make the diagnosis of HHS
- Ketones are rarely present in persons with HHS
- More dehydrated
DKA
- Starving in this state
Clinical picture: tachypneic to compensate for acidosis pH 7.2, kusmual breaths, fruity breath
- Ketones are in the urine
CO2 drops
Tx: rehydration, reverse the acidosis with fluids and electrolyte replacement, slow rehydration
to prevent cerebral edema
- With insulin, monitored every hour, insulin drips IV, NPH only one able to be in IV
Hyponatremic and hypokalemic for DKA
Bacteria loves sugar, recurring yeast infections are common
Metformin
- Huge GI issues
- Take it forever
- Stop taking it before contrast dye interacts lactic acidosis renal damage
Always has a tray of food before doing the insulin
- Make sure the patient likes the food
Check urine for ketones!!!!