Diabetes
August 2012
ENDOCRINE DISEASES AND CONDITIONS
Type I or Type II
Type I
Type II
Juvenile diabetes
Most common form of
diabetes
Usually diagnosed in children
and young adults
Millions diagnosed and many
unaware they have it
Body will not produce insulin
Either the body does not
produce enough insulin or
the cells ignore the insulin
Only 5% of diabetics are a
type I
Symptoms – Type I
Frequent urination
Unusual thirst
Extreme hunger
Unusual weight loss
Extreme fatigue and irritability
Symptoms – Type II
Any of the type I symptoms
Frequent infections
Blurred vision
Cuts and bruises that are slow to heal
Tingling or numbness in the hands or feet
Recurring skin, gum or bladder infections
Prevention
Type II can be prevented or delayed
Lead a healthy lifestyle
Change your diet
Increase your physical activity
Maintain a health weight
Myths
• Diabetes is not that serious of a disease
• If you are over weight you will eventually
develop type II diabetes
• Eating too much sugar can cause diabetes
• People with diabetes must eat special foods
• People with diabetes cannot eat carbs or
sugars
• It is ok to eat as much fruit as you want
because it is healthy
Diabetic Ketoacidosis (DKA)
Insulin deficiency and excessive stress
hormone
Typically in Type I but can be in Type II
Elevated glucose promotes osmotic diuresis
and dehydration
• Stress hormones stimulate free fatty acids
which cause a release of ketones
• Causes decreased myocardial contractility
and cerebral function
• Usually brought on by infection and stress
Interventions
• Gradually return to normal metabolic
balances
• FSBS and notify the MD of the results
• 2 large bore IV’s
• NS at a rate of 1 liter per hour
• O2 and maintain ABC’s
• Insulin drip per protocol
• Monitor patient every 5-15 minutes until
stable
• Closely monitor intake and output
• Cardiac monitor
Hyperglycemic Hyperosmolar Nonketotic Coma
(HHNC)
• Occurs in type II
• Profound dehydration from elevated glucose
and osmotic diuresis
• No ketones-not enough insulin to start the
process
• Can be caused by infection, stroke or sepsis
• High mortality rates
Interventions
FSBS and notify the MD of the results
May require intubation
2 large bore IV’s
NS 1 liter over 1 hour
Insulin drip per protocol
Monitor the patient every 5-15 minutes until
stable
• Closely monitor the intake and output
• Cardiac monitor
•
•
•
•
•
•
Hyperglycemia
• Serum glucose drops below 50
• Below 35-the brain cannot adequately extract
oxygen
• Results in hypoxia and eventually coma
• Any person with an altered level of
consciousness should be considered to have
low glucose until proven otherwise
Interventions
• O2 and maintain ABC’s
• FSBS and notify MD of results
• If alert and oriented x3, give oral glucose
solutions (oj, milk, etc. )
• Establish IV
• ½ to 1 amp of 50% dextrose (D50) per MD’s
orders
• Monitor the mental status closely
• Monitor the FSBS every 15-30 minutes
• Order a meal tray STAT
• Cardiac Monitor
References
American Diabetic Association
Emergency Nursing Core Curriculum, ENA
Fundamentals of Nursing, Potter and Perry