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Diabetes Complications

2. Diabetic KetoacidosisMost serious complication in Type 1 diabetes. DKA. 3. Precipitating Causes. Not enough insulinSkipping insulinStress, traumaInsulin resistance. 4. Pathophysiology of DKA. See chartKetosisDehydrationElectrolyte imbalance. 5. Symptoms of DKA. Abdominal painAnorexi

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Diabetes Complications

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    1. 1 Diabetes Complications Dr. Kathleen Ethridge Northeast Texas Community College

    2. 2 Diabetic Ketoacidosis Most serious complication in Type 1 diabetes DKA

    3. 3 Precipitating Causes Not enough insulin Skipping insulin Stress, trauma Insulin resistance

    4. 4 Pathophysiology of DKA See chart Ketosis Dehydration Electrolyte imbalance

    5. 5 Symptoms of DKA 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

    6. 6 Assessment DKA Hyperglycemia Hyperosmolality Dehydration Electrolyte imbalances Metabolic acidosis Hypoglycemia Fluid overload

    7. 7 Intervention Rehydrate Reverse shock Give Potassium Corret pH Give insulin

    8. 8 Critical Monitoring Rehydration I & O, Daily Weight Skin turgor, LOC, VS CVP measurement Auscultation of lungs

    9. 9 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

    10. 10 Potassium Replacement in DKA Look at EKG Replacement is based on plasma potassium level Recheck potassium q 2 hours

    11. 11 Correct pH/Give Insulin Give IV Insulin Give Regular Insulin only Initial bolus IV (0.15u/kg) Then Regular Insulin IV drip

    12. 12 HHNK Hyperglycemic, Hyperosmolar Noketotic Syndrome Most commonly occurs in older adults with Type II diabetes Always look for precipitating factors

    13. 13 Factors Associated with HHNK Drugs Procedures Chronic illness Acute illness

    14. 14 Four Major Clinical Features Severe hyperglycemia No or slight ketosis Profound dehydration Hyperosmolality

    15. 15 Treatment Similar to DKA Find underlying cause

    16. 16 Hypoglycemia Also known as insulin reaction or hypoglycemic reaction

    17. 17 Risk Factors Overdose of insulin Omitting a meal Overexertion Nausea and vomiting Alcohol intake

    18. 18 Symptoms of Hypoglycemia 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

    19. 19 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

    20. 20 Acute Complications of Diabetes Compare DKA HHNK Hypoglycemia see chart for comparison

    21. 21 Other Complications Hypoglycemic Unawareness Somogyi Phenomenon Dawn Phenomenon

    22. 22 Chronic Complications Macrovascular Complications Microvascular Complications Neuropathic Complications Mixed

    23. 23 Foot Infections with Diabetes Inspection Footwear Foot Care

    24. 24 Microvascular Complications Retinopathy Nephropathy

    25. 25 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

    26. 26 Neuropathy Mononeuropathy Polyneuropathy

    27. 27 Diabetic Client and Surgery Preoperative care Intraoperative care Postoperative care

    28. 28 Sick Days and Diabetes Individualized plan Monitoring glucose levels ketones insulin nutrition fluids Know when to call the Doctor

    29. 29 Children with Diabetes

    30. 30 Vacation, Travel and Diabetes

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