15/15
When a patient is hypoglycemic, provide them with 15 grams of carbs, wait 15
minutes and recheck blood sugar.
The following items contain 15 grams of carbohydrate:
3–4 glucose tablets
1 dose of glucose gel (in most cases, 1 small tube is one dose)
1/2 cup of orange juice or regular soda (not sugar-free)
1 tablespoon of honey or syrup
1 tablespoon of sugar or 5 small sugar cubes
6–8 LifeSavers
8 ounces of skim (nonfat) milk
Dawn Phenomena
Rise in blood glucose between 4 and 8 a.m.
All people have the “dawn phenomenon,” if they have diabetes or not.
The dawn phenomenon is a surge of hormones that the body produces daily in the
early morning hours before you wake up.
People with diabetes don't have normal insulin responses to adjust for this, and may
see their fasting glucose go up.
Diabetic Ketoacidosis
KKK – Ketoacidosis
• Kussmal Breathing
• Monitor K Levels
• Ketones
FLUIDS FIRST!
Other Symptoms:
Warm Flushed Skin
Dehydration
Rapid Onset
HGA1C
Three month measurement of blood glucose levels
Normal <6.5
COLD AND CLAMMY NEED SOME CANDY
Hypoglycemia
BG <70
Follow 15/15 rule
Hot and Dry = sugar is high
HYPERGLYCEMIA
Metabolic Syndrome
Cluster of abnormalities that increase risk factor for cardiovascular disease and
diabetes.
End orgran disease caused by poorly controlled BG
Nephropathy
End organ disease of kidneys – related to microvascular damage.
Hallmark signs of
Diabetes
Diabetic Retinopathy
End organ disease of the eyes related to microvascular damage
Waist to hip ratio --Low risk Females -- < 0.80
High Risk Females -- >0.85
Low risk Males -- < 0.95
High Risk Males -- >1.0
High risk = more prone to HD and DM
ADDISONS –
AAA
Absence of Adrenal Hormones
Anorexia
A color change
A loss of hair
A disinterest in sex
Auto immune or A sudden stop in steroid treatment
Amenorrhea
Abdominal pain
VAGUE presentation
================================================
Hyponatremia
Hypotension
Hypovolemia
Hyperpigmentation
Hyperkalemia
Cushings Syndrome
Cushings = Cortisol + Cushion
Can be endogenous or exogeneous
More commonly exogenous – taper off steroid use.
Graves disease = an autoimmune disease which causes
hyperthyroidism and will result in goiter and exophthalmos
Hirtsutism
-- Many times, the condition is linked to high levels of male hormones (called
androgens).
Common causes:
Cushing's syndrome, which you get when you have high levels of the stress
hormone cortisol for long periods of time.
Tumors in your adrenal glands (which make hormones like cortisol) or your ovaries.
Myxedema
A symptom of hypothyroidism
-accumulation of polysaccharides in sub-q tissue
-face is waxy and expressionless
-If untreated can lead to coma
Rare and life threatening
HYPOTHERMIA
LOC
Thyroid Storm:
Common symptoms of this thyroid dysfunction include:
• heart rate over 140bpm
• fever tachycardia
• atrial fibrillation
• persistent sweating
• mood changes
• shortness of breath
• unconsciousness
• diarrhea
• nausea
• Vomiting
UNTREATED HYPERTHYROIDISM or OVERTREATED HYPOTHYROIDISM
10-20% mortality even if treated
Depressed Respirations ----
Hypoventilation ---
breathing at an abnormally slow rate, resulting in an increased
amount of carbon dioxide in the blood.
Can lead to respiratory acidosis
Hyperventilation –
Hyperventilation is a condition in which you start to breathe very fast. Healthy
breathing occurs with a healthy balance between breathing in oxygen and
breathing out carbon dioxide. You upset this balance when
you hyperventilate by exhaling more than you inhale.
SHALLOW AND RAPID
Kussmaul Breathing
Deep and rapid breathing – associated with Diabetic Ketoacidosis
I got ACID in my lungs!!
If opioid od:
Tachycardia
Decreased LOC
Blurred Vision
Cardiac Arrest
Respiratory Acidosis
•
•
pH
CO2
• Hypoventilation (slow and labored) – May be caused by:
• ACUTE: Aspiration, pulmonary edema, pneumonia, acute asthma, opioid overdose
• CHRONIC: COPD, Stroke or MS
• Interventions:
• Assess airway
• Monitor VS, I&O, ABGs, EKG & Teley
• Hydration
• Pharmacueticals may include: Narcotics Antagonist (Naloxone), bronchiodilators, antibiotics
• O2 and postural draining
I am panicking…my
heart is racing and I
need an ALKoholic
drink!
Respiratory Alkalosis
pH
CO2
Causes: Hyperventilation – anxiety, pain, hypoxia, mechanical hyperventilation
Other signs:
LOC
Dizziness
Palpitations
Parathesias
Tetany
Confusion
Dysrhythmias
“Wow = that drink (ALK) made me all tingling and tired and twitchy.”
Monitor – VS, LOC, ABGs, encourage controlled breathing, Anxiolytics, O2, provide reassurance and
support
Hypotension
I’ve been sick --now I feel sick
and tacky!
Metabolic Alkalosis
pH
BiCarb
Causes of increased BiCarb can be related to:
Acid loss – vomiting, suctioning, hypokalema, or
BiCarb in – Sodium bicarb ingestion (antacids or IV fluids), massive transfusions
GI LOSSES – EXEMPLAR:
Excessive GI losses – thru vomit, suction, diuretics, pyloric stenosis, post surgical, volume depletion
Other signs:
Interventions:
•
•
•
•
•
•
Administer IVF , K+ and Lyte replacement
Monitor I&O, VS, RESP status
Neuro/muscular
O2 therapy
***Treat underlying cause***
LOC
BP
Confusion
Compensatory hypoventilation
Tetany/seizures
Dysrhythmias
There’s ACID in my
BOLood! It’s making
me warm and
mushy.
Metabolic Acidosis
pH
BiCarb
Causes of decreased Bicarb include – Diahrrea
Causes of increased Acid Production – DKA, lactic acidosis, cailcylate toxicity or decreased acid
removal by kidneys
Diabetic Ketoacidosis – EXEMPLAR
• Hyperglycemia
• Dehydration ***
• Electrolyte Loss
• Additional manifestations – fruity breath, rapid onset, ketones in urine
Nursing -- ***Treat fluid volume depletion first, Monitor K+ levels, replace insulin after k+ level is
known. IV Sodium bicarb for pH < 7.1 cautiously.