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Complications of Diabetes Mellitus: Hyperglycemic Crises and Hypoglycemia - Prof. Isabella, Study notes of Health sciences

An in-depth analysis of the acute and chronic complications of diabetes mellitus, focusing on diabetic ketoacidosis (dka), hyperosmolar hyperglycemic non-ketotic coma (hhnk), and hypoglycemia. It covers causes, prevention, pathophysiology, assessment, treatment, and signs & symptoms for each complication. Newly diagnosed diabetics are advised on how to prevent these reactions.

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Pre 2010

Uploaded on 08/16/2009

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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