72 Questions
What is hypoglycemia?
Low sugar in the blood
What can cause hypoglycemia?
Skipping meals and excessive insulin
When may midmorning hypoglycemia occur?
When the morning insulin is peaking
What are the clinical manifestations of hypoglycemia?
Sweating and tachycardia
What is the blood glucose level for hypoglycemia?
Less than 70 mg/dL
What causes the sympathetic nervous system to be stimulated in hypoglycemia?
Low blood glucose level
What are the symptoms of moderate hypoglycemia?
Inability to concentrate, confusion, slurred speech, and double vision
What is the immediate treatment for hypoglycemia?
15 to 20g of fast-acting concentrated carbohydrates
What causes Diabetic Ketoacidosis (DKA)?
An absence or inadequacy of insulin
What leads to increased gluconeogenesis and hyperglycemia in the absence of insulin?
Reduced glucose entry into cells
What is a cause of DKA during illness?
Missed insulin doses
What are the 'sick day rules' for preventing DKA during illness?
Not eliminating insulin doses when nauseous or vomiting and consuming frequent small portions of carbohydrates
What insulin administration changes are recommended for hospitalized patients with diabetes?
Eliminating rapid-acting insulin, reducing intermediate-acting insulin, and using frequent dosing of rapid-acting insulin
What may be given to prevent hypoglycemia and provide calories for hospitalized patients with diabetes who are not eating?
IV dextrose
What insulin regimens may be used for hospitalized patients NPO for an extended period?
NPH insulin every 12 hours, rapid-acting insulin every 4 to 6 hours, or an IV insulin drip
Why should diagnostic tests, procedures, and surgeries for patients with diabetes be scheduled early in the morning?
To avoid the need to withhold food
What do enteral tube feedings for patients with diabetes contain more of, affecting blood glucose levels?
Simple carbohydrates
What are hospitalized patients with diabetes at increased risk for, requiring daily dental care and assistance in maintaining skin hygiene?
Periodontal disease and skin breakdown
How can pressure on the heels be alleviated for a patient in the supine position?
Elevating the lower legs on a pillow with the heels hanging off the edge
When seated in a chair, how should a patient's feet be positioned to prevent heel pressure?
So that pressure is not placed on the heels
What should a nurse provide to a patient with an ulceration on one foot?
Preventive care to the unaffected foot and special care to the affected foot
What should be included in diabetes self-management education?
Daily oral, skin, and foot care
What additional instruction should female patients receive?
Measures for the avoidance of vaginal infections
Why is it important for nurses to emphasize personal hygiene during hospitalization?
Patients often take cues from nurses and understand the importance of hygiene
Which of the following symptoms is NOT typically associated with Diabetic Ketoacidosis (DKA)?
Minimal or absent ketosis
What triggers Hyperglycemic Hyperosmolar Syndrome (HHS) most commonly?
An illness, medication, or acute event
What is a key difference in the presentation of DKA and HHS?
Lack of ketosis in HHS
How long may it take for neurologic symptoms to clear after treatment for HHS?
3 to 5 days
Which intervention is NOT part of the management for Hyperglycemic Hyperosmolar Syndrome (HHS)?
Administration of oral antidiabetic medications
What adjustment is necessary for patients with diabetes who must be NPO (nothing by mouth)?
Adjustments in insulin dosage
What is the blood glucose level indicating hypoglycemia?
Less than 70 mg/dL (3.9 mmol/L)
What are the clinical manifestations of mild hypoglycemia?
Sweating, tremor, tachycardia, and hunger
What is the immediate treatment for hypoglycemia?
Consuming 15-20 grams of glucose or simple carbohydrates
What is the main cause of hypoglycemia?
Too much insulin or oral hypoglycemic agents
When does midmorning hypoglycemia often occur?
When the morning insulin is peaking
What are the symptoms associated with the sympathetic nervous system stimulation in hypoglycemia?
Sweating, tremor, tachycardia, and nervousness
How can pressure on the heels be alleviated for a patient in the supine position?
Elevating the lower legs on a pillow with the heels positioned over the edge of the pillow
What should be emphasized when educating female patients about diabetes self-management?
Measures for the avoidance of vaginal infections
How should the feet be positioned when a patient is seated in a chair to prevent pressure on the heels?
Positioned so that pressure is not placed on the heels
What should the nurse provide for a patient with an ulceration on one foot?
Preventive care to the unaffected foot and special care of the affected foot
What should be emphasized during the hospitalization of patients with diabetes?
The importance of daily personal hygiene
What is the recommended position for the lower legs when a patient is in the supine position to alleviate pressure on the heels?
Elevated on a pillow with the heels positioned over the edge of the pillow
Which of the following is a characteristic of Hyperglycemic Hyperosmolar Syndrome (HHS)?
Presence of hyperosmolality and hyperglycemia
What is a key difference between Diabetic Ketoacidosis (DKA) and HHS?
Presence of ketosis and acidosis
What is a precipitating factor for Hyperglycemic Hyperosmolar Syndrome (HHS)?
Acute illnesses
What is the immediate treatment for hypoglycemia?
15 to 20 g of fast-acting concentrated carbohydrate
What is a clinical manifestation of Diabetic Ketoacidosis (DKA)?
Orthostatic hypotension
What is a cause of Diabetic Ketoacidosis (DKA)?
Missed insulin doses
What is the treatment approach for Hyperglycemic Hyperosmolar Syndrome (HHS)?
Fluid replacement, correction of electrolyte imbalances, and insulin administration
What is the result of insulin deficiency in Diabetic Ketoacidosis (DKA)?
Increased gluconeogenesis and ketone body production
What is important for preventing recurrence of Hyperglycemic Hyperosmolar Syndrome (HHS)?
Frequent self-blood glucose monitoring
How can patients prevent dehydration during illness?
Consume frequent small portions of carbohydrates and fluids
What should patients have during illness to manage diabetes?
A 'sick day' kit with urine and blood glucose test strips
What should be assessed after the acute phase of Diabetic Ketoacidosis (DKA)?
Underlying causes
What insulin regimens may be used for hospitalized patients NPO for an extended period?
NPH insulin every 12 hours, rapid-acting insulin only every 4 to 6 hours, or an IV insulin drip
What should be provided to prevent hypoglycemia and provide calories for hospitalized patients with diabetes who are not eating?
IV dextrose
What causes a rapid rise in blood glucose levels when eaten alone, requiring matching of peak times of insulin effect with peaks in the blood glucose concentration?
Simple carbohydrates
What must be given at regular intervals when continuous tube feedings are provided to patients with diabetes?
Insulin doses
What may result from inadvertent or purposeful discontinuation of continuous tube feedings in patients receiving insulin?
Hypoglycemia
What should be monitored and given at regular intervals for patients receiving continuous parenteral nutrition?
Blood glucose level and insulin
What type of insulin administration is crucial for type 1 diabetes patients who are NPO?
Basal insulin
What may lead to diabetic ketoacidosis (DKA) in type 1 diabetes patients who are NPO?
Elimination of insulin doses
What insulin dosing changes may be needed for hospitalized patients with diabetes?
Eliminating rapid-acting insulin and decreasing intermediate-acting insulin
What should clear liquid diets for diabetic patients in hospitals include?
Simple carbohydrate foods like juice and gelatin desserts
What may enteral tube feedings in diabetic patients lead to?
Increased glucose levels
What is important for preventing periodontal disease and skin issues in hospitalized diabetic patients?
Focused attention on oral hygiene and skin care
What is a crucial management strategy for type 1 diabetes patients who are nil per os (NPO)?
Regular glucose testing and insulin administration
What is a potential consequence for type 1 diabetes patients if insulin doses are eliminated?
Diabetic ketoacidosis (DKA)
What insulin administration changes are necessary for hospitalized patients with diabetes NPO for an extended period?
IV insulin drip
What is essential for diabetic patients receiving parenteral nutrition?
Regular glucose testing
What is a potential consequence of discontinuation of enteral tube feedings for diabetic patients receiving insulin?
Hypoglycemia
What should nurses assess for in diabetic patients to prevent skin breakdown?
Symptoms of neuropathy
Study Notes
Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS)
- DKA's hyperglycemia leads to polyuria, polydipsia, fatigue, blurred vision, weakness, and headache, and can result in orthostatic hypotension, hypotension, acetone breath, and Kussmaul respirations.
- Mental status in DKA varies, with patients being alert, lethargic, or comatose.
- HHS, mainly in older adults with type 2 diabetes, is characterized by hyperosmolality and hyperglycemia with minimal or absent ketosis.
- HHS is often triggered by an illness, medication, or acute event and presents with polyuria, polydipsia, hypotension, dehydration, and variable neurologic signs.
- Distinguishing HHS from DKA, HHS does not involve ketosis and acidosis due to differences in insulin levels.
- HHS management involves fluid replacement, correction of electrolyte imbalances, and insulin administration, with close monitoring of volume and electrolyte status.
- Treatment of HHS may take 3 to 5 days for neurologic symptoms to clear and may continue well after metabolic abnormalities have resolved.
- After recovery from HHS, many patients can control their diabetes with Medical Nutrition Therapy (MNT) or oral antidiabetic medications, with insulin not always being needed.
- Insulin is given at a continuous low rate to treat hyperglycemia, and replacement IV fluids with dextrose are given after the glucose level decreases to a certain range.
- Frequent self-blood glucose monitoring (SBGM) is important in preventing the recurrence of HHS.
- Patients who must be NPO require adjustments in insulin dosage.
- Dietary modifications during hospitalization for patients with diabetes require special consideration.
Hypoglycemia and Diabetic Ketoacidosis: Symptoms, Management, and Prevention
- Moderate hypoglycemia symptoms include impaired CNS function like headache, confusion, and slurred speech
- Severe hypoglycemia symptoms may include disoriented behavior, seizures, and loss of consciousness
- Immediate treatment for hypoglycemia involves 15 to 20 g of fast-acting concentrated carbohydrate
- Diabetic Ketoacidosis (DKA) is caused by insulin deficit, leading to hyperglycemia, dehydration, and acidosis
- Insulin deficiency results in increased gluconeogenesis and ketone body production, leading to metabolic acidosis
- Causes of DKA include missed insulin doses, illness, infection, and undiagnosed diabetes
- Patients may make errors in insulin dosage during illness, resulting in decreased insulin levels
- Illness and infections contribute to insulin resistance, leading to hyperglycemia and potential progression to DKA
- Prevention of DKA during illness involves managing diabetes with "sick day rules," including not eliminating insulin doses during nausea and vomiting
- Patients are taught to consume frequent small portions of carbohydrates and fluids to prevent dehydration during illness
- Patients should have a "sick day" kit with urine and blood glucose test strips and know how to contact their primary provider 24/7
- After the acute phase of DKA, underlying causes should be assessed by the nurse
Managing Diabetes in Hospitalized Patients
- Management strategies for diabetic patients in hospitals include adjusting insulin doses, using IV dextrose to avoid hypoglycemia, and monitoring glucose levels closely.
- Type 1 diabetes patients may develop diabetic ketoacidosis (DKA) if insulin doses are eliminated.
- Basal insulin administration is crucial for type 1 diabetes patients who are nil per os (NPO).
- Type 2 diabetes patients on insulin may not develop DKA when insulin doses are skipped due to endogenous insulin production, but close glucose monitoring is essential.
- Regular glucose testing and insulin administration are necessary for patients NPO for extended periods, with insulin regimens including NPH insulin, rapid-acting insulin, or IV insulin drip.
- Diagnostic tests, procedures, and surgeries for diabetic patients should be scheduled early in the morning to minimize the need for food withholding.
- Clear liquid diets in hospitals for diabetic patients should include simple carbohydrates like juice and gelatin desserts to maintain nutritional status and promote healing.
- Enteral tube feedings can cause increased glucose levels in diabetic patients, necessitating regular insulin dosing and careful monitoring to prevent hypoglycemia and hyperglycemia.
- Hypoglycemia in patients receiving tube feedings and insulin may result from discontinuation of the feeding, requiring alterations in insulin doses or administration of IV dextrose.
- Diabetic patients receiving parenteral nutrition may require IV and subcutaneous insulin, with regular blood glucose monitoring and insulin administration to coincide with parenteral nutrition infusion times.
- Hospitalized diabetic patients require focused attention on oral hygiene, skin care, and prevention of skin breakdown, including daily dental care, skin assessments, and foot care to prevent neuropathy-related complications.
- Nurses should assess for symptoms of neuropathy, such as tingling, pain, numbness, and reduced deep tendon reflexes, and provide appropriate care to prevent skin breakdown, especially at pressure points.
Test your knowledge of Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS) with this quiz. Explore the differences in symptoms, management, and treatment approaches for these two serious diabetic complications.
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