Download Complications of Diabetes Mellitus: Hyperglycemic Crises and Hypoglycemia - Prof. Isabella and more Study notes Health sciences in PDF only on Docsity! Complications of DM Acute Chronic Acute Complications of DM Hyperglycemia Diabetic Ketoacidosis Hyperosmolar Hyperglycemic NonKetotic Coma (HHNK) aka Hyperosmolar Hyperglycemic NonKetotic Syndrome(HHNS) Hypoglycemia Newly Dx’ed diabetic needs to know: Why reactions occur When reactions most likely to occur Early clinical manifestations (S & Sx) Danger of severe or repeated reactions Importance of early treatment How to prevent these reactions Diabetic Ketoacidosis Cause (of hyperglycemia) – Too little insulin (or omitting doses) – increased need for insulin or insulin resistance Prevention • Triad of Treatment • Sick Days DKA - Pathophysiology Hyperglycemia (Increased blood glucose) But body increases glucose production!!! (Glycogenolysis & Gluconeogenesis) Ketosis Metabolic Acidosis (Decreased blood pH) Ketonuria / Glucosuria – Dehydration – Hyperosmolarity – Hypotension Kussmaul’s Respirations • Fruity Odor DKA Pathophysiology cont’d Hypovolemia
7 Na, f BUN, f Het
– Shock HHNK - Signs and Symptoms Severe Dehydration Neurological changes HHNK - Treatment Vigorous Fluid Replacement = #1 Rx – 1/2 Normal Saline Insulin IV Push & Drip/Pump Electrolytes Treat underlying cause Hypoglycemia (Insulin Reaction) Blood sugar < 50 ( brain damage) Usually Type 1 Causes – Too much insulin – Not enough food (skipping a meal) – ETOH (alcohol lowers blood sugar) – overexertion – retinopathy - so administering too much insulin – nephropathy - so oral meds not excreted (Type 2) – some meds. & diseases blood sugar, some blood sugar Signs & Symptoms (some similar to us when we get hungry, but more severe) Sudden -Adrenergic (stress response) • diaphoresis, irritability, tachycardia, shakiness, pallor (blunted by beta- blockers!!!) Later – Neuroglypenic ( blood sugar to brain, so neuro. Sxs) • confusion, headache, lack of muscle coordination, slurred speech, blurred vision, irrational behavior, consciousness, coma, death Treatment Glucose • fast acting – Orange Juice • follow with longer acting = carb + protein (8oz. milk) • [glucagon (only lasts 1/2 hr.)] • IV – Dextrose (10-25 g over 1-3 min.) – then D5W IV at 5-10 g/hr. Retest in 15 minutes
