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Diabetes Complications. Dr. Kathleen Ethridge Northeast Texas Community College. DKA. Diabetic Ketoacidosis Most serious complication in Type 1 diabetes. Precipitating Causes. Not enough insulin Skipping insulin Stress, trauma Insulin resistance. Pathophysiology of DKA. See chart
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Diabetes Complications Dr. Kathleen Ethridge Northeast Texas Community College
DKA • Diabetic Ketoacidosis • Most serious complication in Type 1 diabetes
Precipitating Causes • Not enough insulin • Skipping insulin • Stress, trauma • Insulin resistance
Pathophysiology of DKA • See chart • Ketosis • Dehydration • Electrolyte imbalance
Abdominal pain Anorexia Dehydration Fuity breath Kussmaul’s Change LOC Hypotension N&V Polyuria Somnolence Tachycardia Thirst Visual disturbances Warm, dry skin Weakness Wt. loss Symptoms of DKA
Assessment DKA • Hyperglycemia • Hyperosmolality • Dehydration • Electrolyte imbalances • Metabolic acidosis • Hypoglycemia • Fluid overload
Intervention • Rehydrate • Reverse shock • Give Potassium • Corret pH • Give insulin
Critical Monitoring • Rehydration • I & O, Daily Weight • Skin turgor, LOC, VS • CVP measurement • Auscultation of lungs
IV Fluids in DKA • Hour 1 • N/S or Ringer’s lactate (15-20ml/kg) • Hour 2 • Continue fluid, consider half-strength NS • Hour 3 • Reduce fluid intake to 7.5ml/kg, use half-strength NS • Hour 4 • Consider urine output in adjusting fluids
Potassium Replacement in DKA • Look at EKG • Replacement is based on plasma potassium level • Recheck potassium q 2 hours
Correct pH/Give Insulin • Give IV Insulin • Give Regular Insulin only • Initial bolus IV (0.15u/kg) • Then Regular Insulin IV drip
HHNKHyperglycemic, Hyperosmolar Noketotic Syndrome • Most commonly occurs in older adults with Type II diabetes • Always look for precipitating factors
Factors Associated with HHNK • Drugs • Procedures • Chronic illness • Acute illness
Four Major Clinical Features • Severe hyperglycemia • No or slight ketosis • Profound dehydration • Hyperosmolality
Treatment • Similar to DKA • Find underlying cause
Hypoglycemia • Also known as insulin reaction or hypoglycemic reaction
Risk Factors • Overdose of insulin • Omitting a meal • Overexertion • Nausea and vomiting • Alcohol intake
Adrenergic Shakiness Irritability Nervousness Tachycardia Tremor Hunger Diaphoresis Pallor Paresthesias Neuroglycopenic Headache Mental illness Inability to concentrate Slurred speech Blurred vision Confusion Irrational behavior Lethargy LOC, coma, seizure Symptoms of Hypoglycemia
Interventions • Mild • carbohydrate 10-15 gram • Moderate • 20-30 gram of carbs • Glucagon, 1 mg SC or IM • Severe • 50% dextrose 25 g IV • Glucagon 1 mg IM or IV
Acute Complications of Diabetes • Compare • DKA • HHNK • Hypoglycemia • see chart for comparison
Other Complications • Hypoglycemic Unawareness • Somogyi Phenomenon • Dawn Phenomenon
Chronic Complications • Macrovascular Complications • Microvascular Complications • Neuropathic Complications • Mixed
Foot Infections with Diabetes • Inspection • Footwear • Foot Care
Microvascular Complications • Retinopathy • Nephropathy
Visual Complications of Diabetes • Education of client • Diabetic retinopathy can lead to blindness • Check blood sugar • Check blood pressure • Regular eye exam with ophthalmologist • Laser photocoagulation therapy
Neuropathy • Mononeuropathy • Polyneuropathy
Diabetic Client and Surgery • Preoperative care • Intraoperative care • Postoperative care
Sick Days and Diabetes • Individualized plan • Monitoring • glucose levels • ketones • insulin • nutrition • fluids • Know when to call the Doctor