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Patho: autoimmune response, genetic, no insulin production
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S/S: Younger than 35, slimmer, dry skin, fatigue, decreased wound healing
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Patho: onset is accelerated by obesity and sedentary lifestyle. Insulin resistance, impaired insulin secretion
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Risk Factors: Systolic BP >130, Fasting BG >100, Overweight (waist size 35+ Female, 45+ Male), High Cholesterol.
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Treatment: Diet & Exercise, Oral medication, Insulin
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Placental hormones cause insulin resistance.
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All women are screened 24-28 weeks gestation.
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More likely to develop Type II within 10 years.
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Treatment: Diet & Exercise, blood sugar monitoring, insulin
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Total Cholesterol
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< 200
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Triglycerides
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< 150
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LDL
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< 100
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HDL
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40+
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Patho: BG < 70 mg/dL
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Causes: too much insulin or oral hypoglycemic agents, too little food, excessive physical activity
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Mild S/S: sweating, tremor, tachycardia, palpitation, nervousness, and hunger
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Moderate S/S: inability to concentrate, headache, lightheadedness, confusion, memory lapses, numbness of the lips and tongue, slurred speech, ALOC, drowsiness, double vision, emotional changes
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Severe S/S: disoriented behavior, seizures, difficulty arousing from sleep, loss of consciousness
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Nursing Interventions: Immediately treat with 15-20g of simple carbohydrates (ex.juice), Adults w/ BG <54 or unconscious and can't swallow - inject glucagon IM or SQ, In a hospital setting for pts who are unconscious or can't swallow - admin 25-50mL of D50W
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Pt Education: pattern of eating, medication or insulin admin, emergency simple carbohydrates on hand, high calorie/high fat foods slow the absorption of glucose
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Patho: BG > 100
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Causes: sepsis (infection), stress (surgery), skip insulin, steroids ("sone")
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Treatment: Give insulin, antibiotics if necessary, and NS
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DKA
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HHNS
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More common in Type I
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More common in Type II
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Onset
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Rapid (<24h)
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Several days
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Causes
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Causes- Infection, Surgery, Stress, Stroke, MI, skipping insulin, untreated DM1, steroid use
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Causes- Infection, Surgery, Stress, Stroke, MI, medications (ex. thiazides), treatments (ex. dialysis)
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Blood Glucose Levels
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> 250 mg/dL
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> 600 mg/dL
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S/S
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3 P's, Kussmaul respirations, fruity breath, blurred vision, weakness, headache, n/v
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Hypotension, frequent urination, dehydration, tachycardia, ALOC, seizures
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pH
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<7.3 (metabolic acidosis)
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Normal
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Urine Ketones
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Present
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Absent
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BUN & Creatinine
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Elevated
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Elevated
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Nursing Priorities
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Fluid replacement, correction of electrolyte imbalance, insulin administration
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Fluid replacement (Isotonic IV, no LR), correction of electrolyte imbalance, insulin administration
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Monitor K+ for hypokalemia
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Monitor K+ for hypokalemia
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Nursing Interventions
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Monitor VS, I&O, assess for dehydration hourly. Monitor for fluid overload. Monitor for cerebral edema.
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Monitor VS, I&O, assess for dehydration hourly. Monitor for fluid overload. Monitor for cerebral edema.
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