ANS 1 : Week 4: Diabetes and Acute and Chronic Complications of Diabetes
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Questions and Answers

A newly diagnosed patient exhibits polyuria, polydipsia, and significant weight loss, but no signs of obesity. Initial blood tests reveal very low insulin levels. Based on this information, which primary defect is most likely present?

  • Insulin resistance with compensatory insulin oversecretion
  • Inappropriate insulin secretion due to liver dysfunction
  • Increased glucagon production by pancreatic alpha cells
  • Loss of pancreatic beta cells (correct)

A patient with diabetes experiences frequent and unpredictable fluctuations in blood glucose levels, particularly after changes in diet, exercise, or insulin dosage. Which treatment strategy would be MOST effective for this patient?

  • Consistent carbohydrate intake coupled with fixed daily insulin doses
  • Oral anti-diabetic medications to improve insulin sensitivity, regardless of dietary intake
  • Strict calorie restriction and increased exercise, without adjusting insulin dosage
  • Flexible insulin dosing based on carbohydrate intake and activity levels, along with frequent blood glucose monitoring (correct)

A patient with a history of diabetes presents with fatigue, increased thirst, and frequent urination. Labs reveal elevated blood glucose and the presence of ketones in the urine. Which condition is the MOST likely cause of these findings?

  • Hyperosmolar hyperglycemic state (HHS) due to excessive carbohydrate intake
  • Hypoglycemia induced by over-administration of insulin
  • Diabetic ketoacidosis (DKA) resulting from insulin deficiency (correct)
  • Lactic acidosis secondary to metformin use

A patient newly diagnosed with diabetes is obese, has normal to high insulin levels, and shows no signs of ketosis. Which treatment plan is MOST appropriate as an initial approach?

<p>Oral anti-diabetic medications, exercise, and a reduced-calorie diet (D)</p> Signup and view all the answers

Which of the findings below would lead a clinician to suspect that a patient's diabetes is related to the loss of pancreatic beta cells rather than being related to insulin resistance?

<p>Patient developed ketosis (A)</p> Signup and view all the answers

Which of the following best describes the primary function of insulin in the body?

<p>Facilitating the entry of glucose into muscle and fat cells. (A)</p> Signup and view all the answers

A 25-year-old patient is diagnosed with Type 1 diabetes. Which characteristic is most commonly associated with this type of diabetes?

<p>Often presents with a lean body type. (C)</p> Signup and view all the answers

Gestational diabetes increases the risk of which long-term health problem for the mother?

<p>Type 2 diabetes. (A)</p> Signup and view all the answers

Which of the following factors is NOT a known cause of secondary diabetes?

<p>Hypothyroidism. (D)</p> Signup and view all the answers

A patient with a history of recurrent pancreatitis develops hyperglycemia. This is most likely an example of which type of diabetes?

<p>Secondary diabetes. (C)</p> Signup and view all the answers

Which of the following statements best describes the etiology of Type 2 Diabetes Mellitus?

<p>It is multifactorial, involving both insulin resistance and impaired insulin secretion. (D)</p> Signup and view all the answers

A distinguishing factor between Type 1 and Type 2 diabetes is that Type 1 diabetes:

<p>Involves a complete or near-complete deficiency of insulin. (A)</p> Signup and view all the answers

Which of the following conditions associated with secondary diabetes is directly caused by a medical treatment?

<p>Use of thiazide diuretics. (A)</p> Signup and view all the answers

Which of the following is the least likely characteristic of untreated Type 2 Diabetes?

<p>Ketosis (D)</p> Signup and view all the answers

A patient is diagnosed with prediabetes. What is the primary nursing implication for this diagnosis?

<p>Educating the patient on lifestyle modifications to prevent or delay the onset of Type 2 Diabetes. (A)</p> Signup and view all the answers

Which combination of factors is most indicative of metabolic syndrome?

<p>Elevated glucose levels, abdominal obesity, and decreased HDL levels. (A)</p> Signup and view all the answers

What is the primary differentiating factor between Type 1 and Type 2 Diabetes regarding insulin production?

<p>Type 2 Diabetes involves some endogenous insulin production, while Type 1 does not. (A)</p> Signup and view all the answers

A patient with Type 2 Diabetes also has hypertension and elevated lipid levels. Which of the following complications is this patient most at risk for?

<p>Damage to blood vessels (B)</p> Signup and view all the answers

Which of the following is the most likely treatment approach for a newly diagnosed patient with Type 2 Diabetes?

<p>Lifestyle modifications including diet and exercise, possibly combined with oral anti-diabetic medications. (D)</p> Signup and view all the answers

In type 2 diabetes, when cells do not receive enough glucose, what compensatory mechanism is triggered in the liver?

<p>The liver releases more glucose into the bloodstream. (B)</p> Signup and view all the answers

What primary physiological process is affected by insulin resistance in Type 2 Diabetes?

<p>Reduced effectiveness of insulin in stimulating glucose uptake by tissues (C)</p> Signup and view all the answers

How does altered production of hormones and cytokines by adipose tissue contribute to the pathophysiology of type 2 diabetes?

<p>It leads to chronic inflammation, which contributes to insulin resistance. (B)</p> Signup and view all the answers

Which of the following is most likely to occur as a result of the altered production of hormones and cytokines by adipose tissue in individuals with Type 2 Diabetes?

<p>Chronic inflammation (C)</p> Signup and view all the answers

A patient with prediabetes is overweight and has a family history of Type 2 Diabetes. Which intervention is most appropriate to delay or prevent the onset of Type 2 Diabetes?

<p>Recommending weight loss and regular physical activity. (C)</p> Signup and view all the answers

A patient with type 2 diabetes reports experiencing increased thirst, frequent urination, and increased hunger. Which of the following best explains the underlying cause of these symptoms?

<p>The body's attempt to eliminate excess glucose through urine. (B)</p> Signup and view all the answers

Why might a person have type 2 diabetes for a long time without knowing it?

<p>The body is still producing some insulin, which masks the symptoms. (D)</p> Signup and view all the answers

Which of the following is the most likely long-term consequence of the combined effects of hyperglycemia and hyperinsulinemia in individuals with Type 2 Diabetes?

<p>Damage to blood vessels (D)</p> Signup and view all the answers

What is the primary goal of nutritional therapy in the management of type 2 diabetes?

<p>To match caloric intake with insulin therapy and physical activity. (A)</p> Signup and view all the answers

Why might strenuous exercise increase blood glucose levels in a patient with type 2 diabetes?

<p>A stress response may be evoked, leading to increased glucose production . (B)</p> Signup and view all the answers

Which of the following is a key difference in the onset and prevalence between type 1 and type 2 diabetes?

<p>Type 1 diabetes usually presents in childhood with an abrupt onset, while type 2 diabetes typically develops gradually and accounts for 90-95% of cases. (A)</p> Signup and view all the answers

A patient with type 2 diabetes experiences a foot ulcer that is slow to heal. Which of the following factors contributes MOST to impaired wound healing in this patient?

<p>Impaired immune response and reduced circulation. (A)</p> Signup and view all the answers

Diabetes mellitus is solely caused by defects in insulin secretion.

<p>False (B)</p> Signup and view all the answers

Insulin primarily targets kidney cells to facilitate glucose entry.

<p>False (B)</p> Signup and view all the answers

Type 1 diabetes accounts for 90-95% of all diabetes cases.

<p>False (B)</p> Signup and view all the answers

Type 2 diabetes typically presents in individuals under 30 years of age.

<p>False (B)</p> Signup and view all the answers

Gestational diabetes is a condition of glucose intolerance that only happens after pregnancy

<p>False (B)</p> Signup and view all the answers

Blood glucose levels in Type 1 diabetes are typically more stable compared to Type 2 diabetes due to the consistent insulin replacement therapy.

<p>False (B)</p> Signup and view all the answers

The onset of Type 1 Diabetes is typically gradual.

<p>False (B)</p> Signup and view all the answers

Family history is frequently negative in individuals with Type 1 Diabetes.

<p>False (B)</p> Signup and view all the answers

In Type 1 diabetes, the primary defect involves insulin resistance, whereas Type 2 diabetes is characterized by the loss of pancreatic beta cells.

<p>False (B)</p> Signup and view all the answers

Cushing syndrome and hyperthyroidism can be underlying medical conditions that lead to secondary diabetes.

<p>True (A)</p> Signup and view all the answers

Individuals with Type 2 diabetes usually exhibit symptoms such as polyuria, polydipsia, and polyphagia, which are less pronounced or absent in Type 1 diabetes.

<p>False (B)</p> Signup and view all the answers

In Type 1 diabetes, reduced weight is prevalent at diagnosis, whereas obesity is only rarely observed in Type 2 diabetes.

<p>False (B)</p> Signup and view all the answers

Ketosis is more commonly observed in Type 2 diabetes, particularly when oral anti-diabetic medications are insufficient to manage blood glucose levels.

<p>False (B)</p> Signup and view all the answers

In type 2 diabetes, the liver's increased glucose production is primarily triggered by the beta cells failing to meet insulin demands.

<p>False (B)</p> Signup and view all the answers

The chronic inflammation associated with altered adipokine production in type 2 diabetes primarily contributes to impaired kidney function.

<p>False (B)</p> Signup and view all the answers

Visual changes in type 2 diabetes, caused by retinopathy, result from the body's decreased insulin sensitivity which damages ocular structures.

<p>False (B)</p> Signup and view all the answers

Moderate exercise will always necessitate carbohydrate supplementation for individuals with type 2 diabetes to prevent any potential elevation of blood glucose.

<p>False (B)</p> Signup and view all the answers

In Type 2 Diabetes, individuals always exhibit low insulin levels due to a deficiency in insulin secretion.

<p>False (B)</p> Signup and view all the answers

Type 2 diabetes commonly presents with rapid onset of classic type 1 diabetes symptoms, such as severe weight loss, particularly in early adulthood.

<p>False (B)</p> Signup and view all the answers

Prediabetes is characterized by glucose levels that meet the diagnostic criteria for Type 2 Diabetes.

<p>False (B)</p> Signup and view all the answers

In type 2 diabetes, frequent infections are primarily due to the upregulated immune response caused by constant antigen stimulation.

<p>False (B)</p> Signup and view all the answers

If blood glucose levels can be consistently maintained within the normal range through dietary modifications alone, drug therapy is not typically required for individuals diagnosed with type 2 diabetes.

<p>True (A)</p> Signup and view all the answers

A diagnosis of metabolic syndrome requires all five components: elevated glucose, abdominal obesity, elevated blood pressure, high triglycerides, and decreased HDLs.

<p>False (B)</p> Signup and view all the answers

Type 2 diabetes is primarily caused by an autoimmune reaction that destroys pancreatic beta cells, leading to insufficient insulin production.

<p>False (B)</p> Signup and view all the answers

Unlike Type 1 Diabetes, individuals with Type 2 Diabetes do not produce any endogenous insulin.

<p>False (B)</p> Signup and view all the answers

The onset of Type 2 Diabetes is typically acute, with symptoms developing rapidly over a few weeks.

<p>False (B)</p> Signup and view all the answers

Insulin resistance in Type 2 Diabetes only affects glucose uptake by tissues, not glucose regulation by the liver.

<p>False (B)</p> Signup and view all the answers

Metabolic syndrome is a direct cause of Type 1 Diabetes.

<p>False (B)</p> Signup and view all the answers

Individuals with prediabetes are guaranteed to develop Type 2 Diabetes later in life.

<p>False (B)</p> Signup and view all the answers

If blood glucose levels are more stable in Type 2 diabetes than in Type 1, then individuals with Type 2 diabetes never experience hyperglycemia or hypoglycemia.

<p>False (B)</p> Signup and view all the answers

If a patient has hypertension and elevated triglyceride levels, they are automatically diagnosed with metabolic syndrome.

<p>False (B)</p> Signup and view all the answers

Flashcards

Diabetes Mellitus Definition

A group of metabolic disorders with increased blood glucose (hyperglycemia).

Causes of Hyperglycemia

Defects in insulin secretion, defects in insulin action, or both.

Insulin Action

Promotes glucose entry into muscle and fat cells.

Insulin's Target Cells

Muscle cells, adipose cells, and the liver.

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Type 1 Diabetes (DM1)

5% of diabetes cases, often diagnosed in youth, usually lean body type.

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Type 2 Diabetes (DM2)

90-95% of diabetes cases, more prevalent, often in those >35, often overweight.

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Gestational Diabetes

Glucose intolerance during pregnancy, increases risk of DM2 later.

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Secondary Diabetes

Hyperglycemia due to another medical condition or its treatment

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DM1 Family Link

Often linked to genetics and environment.

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DM1 Primary Defect

The primary problem is the loss of pancreatic beta cells.

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DM1 Insulin Levels

Reduced early and absent later.

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DM1 Treatment

Insulin replacement and strict diet.

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DM2 Primary Defect

Insulin resistance and secretion issues.

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Prediabetes

A condition with elevated glucose levels, but not meeting diabetes criteria. It's an intermediate stage and usually asymptomatic.

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Type 2 Diabetes Risk Factors

Age ≥45, family history, overweight/obesity, certain ethnicities, history of gestational diabetes, hypertension, elevated lipid levels.

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Metabolic Syndrome

A cluster of conditions including elevated glucose, abdominal obesity, elevated blood pressure, high triglycerides, and decreased HDLs.

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Type 2 Diabetes Pathophysiology

Insulin resistance and impaired insulin secretion. Some endogenous insulin is still produced.

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Type 2 Diabetes Treatment

Oral anti-diabetic drugs, non-insulin injectables, or insulin, combined with diet and exercise.

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Four Metabolic Factors in DM2

Insulin resistance, pancreatic dysfunction, inappropriate glucose production by the liver, and altered adipokine production.

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Insulin Resistance

Insulin is less effective at stimulating glucose uptake, leading to increased insulin secretion to maintain normal glucose levels.

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Impaired Insulin Secretion

When the pancreas cannot produce enough insulin to overcome insulin resistance

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Inappropriate Glucose Production

The liver inappropriately releases glucose into the bloodstream, even when it is not needed.

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Altered Adipokine production

Adipose tissue releases hormones and cytokines that cause chronic inflammation, contributing to insulin resistance and other metabolic problems.

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DM2: Beta Cell Dysfunction

In DM2, beta cells in the pancreas struggle to produce enough insulin to meet the body's needs.

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DM2: Insulin Resistance

In DM2, cells don't respond properly to insulin, hindering glucose uptake from the bloodstream.

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DM2: Liver's Glucose Production

In DM2, the liver inappropriately releases excess glucose into the bloodstream.

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DM2: Adipokine Alterations

Changes in hormone and cytokine production by adipose tissue leads to chronic inflammation.

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Polydipsia

Increased thirst

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Polyuria

Increased urination

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Polyphagia

Increased hunger

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Nutritional Therapy for DM2

Maintain a balance between food intake and insulin therapy

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Insulin Targets

Muscle, fat (adipose), and liver cells.

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DM1 Onset

Often childhood/adolescence, gradual onset.

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Hyperglycemia in DM2

In DM2, if beta cells can't meet insulin demands, this results.

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Insulin Improper Use (DM2)

In DM2, insulin is not properly used, thus glucose transport into cells is impaired.

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Cell Starvation in DM2

In DM2, cells don't get enough glucose, signaling the liver to release more glucose into blood.

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Chronic Inflammation (DM2)

In DM2, altered hormones and cytokines from fat tissue cause this.

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DM2: Clinical Manifestations

Common symptoms of DM2, though sometimes nonspecific.

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DM2: Undetected Symptoms

Common but often overlooked symptom of DM2 due to continued insulin production.

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DM2: Nutritional Therapy

Key component includes balancing food intake with insulin therapy.

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DM2: Strenuous Exercise

Can increase BG due to stress response.

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DM2 Blood Glucose Stability

Blood glucose levels tend to be more stable in Type 2 diabetes compared to Type 1.

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Body Composition at Diagnosis

DM1 patients are often thin/undernourished at diagnosis, DM2 patients are frequently obese.

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Ketosis in Diabetes

Ketosis is more common in DM1, especially with low insulin. Uncommon in DM2 unless beta cells are destroyed.

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DM2 Symptoms

Similar to DM1, but may be asymptomatic initially.

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Diabetes Management Goal

Hemoglobin A1c goals are involved in the management of diabetic patients.

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What is Prediabetes?

Individuals at risk of developing type 2 diabetes, with glucose levels higher than normal but not meeting diabetes criteria.

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What defines Metabolic Syndrome?

Elevated glucose levels, abdominal obesity, elevated blood pressure, high triglycerides, and decreased HDLs.

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What is Insulin Resistance?

Insulin is less effective at moving glucose into cells, causing higher glucose and insulin levels in the blood.

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How do you treat Type 2 Diabetes?

Oral anti-diabetic medications or insulin, combined with diet and exercise.

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What are initial symptoms of Type 2 Diabetes?

Often asymptomatic initially.

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How does blood glucose fluctuate in Type 2 Diabetes?

More stable than in Type 1 Diabetes.

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Can Ketosis occur in Type 2 Diabetes?

Uncommon, occurs only if beta cells are destroyed.

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How does Type 2 Diabetes typically develop?

Gradual, often undetected and untreated for years.

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What are Risk Factors for DM2?

Family history, age, ethnicity, obesity

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What is Hyperinsulinemia?

Elevated insulin levels in the blood, a sign the body is working harder to get blood sugar into cells.

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Study Notes

Insulin

  • Actions include promoting cellular uptake of glucose, converting glucose into glycogen, and moving Potassium into cells with glucose
  • Review Table for types of insulin:
  • Rapid Acting clarity is clear with a peak in 1-3 hours for 3-5 hours duration like Lispro
  • Short Acting clarity is also clear with a peak lasting 2-4 hours for 5-7 duration like Regular
  • Intermediate Acting Clarity is cloudy with a peak of 4-12 hours lasting 18-24 hours like NPH
  • Long Acting Clarity is Clear with a peakless duration lasting 24 hours like Glargine
  • Insulin is a protein that must be given by injection or it is broken down and destroyed

Nursing Considerations

  • draw shorter acting insulin up first because these are clear solutions
  • If mixing cloudy insulin (NPH) it must be drawn second (clear before cloudy)
  • do not mix long-acting insulins (glargine) with any other insulin; use ONLY insulin syringes
  • Use absorption sites from best to last: abdomen (then arm, then thigh, then buttocks)

Oral Hypoglycemics

  • Biguanides, Metformin is a 1st line of treatment that inhibits glucose production, reduces intestinal absorption, increase sensitivity to insulin

Oral Hypoglycemics: Sulfonylureas- glipizide

  • Stimulates beta cells to secrete insulin, increasing sensitivity to insulin to lower blood glucose
  • Can cause hypoglycemia and weight gain
  • Do not give is NPO and monitor weight

Oral Hypoglycemics: TZDs- pioglitazone

  • Sensitize body tissue to insulin and stimulates insulin receptor to lower blood glucose
  • Can cause Edema
  • Do not use with oral contraceptives There’s a chance of liver dysfunction, cardiovascular issues, and fluid retention. Monitor for that.

Oral Hypoglycemics: SGLT2

  • Limits glucagon absorption, excretes it through urine.
  • Use in I DM and II DM
  • Causes Fournier gangrene, so look for cystitis/candidiasis Also dizziness and hypotension

Non-Pharmacologic Considerations

  • Pancreatic or islet cell transplants are limited.
  • Islet can only last two years

Sick Day Rules

  • Take insulin in tandem or with other usual meds to lower blood glucose.
  • Check blood glucose, urine, and ketones Q3 to 4
  • You’ll get hyperglycemia if you don’t
  • Need to supplement dose of regular insulin
  • Substitute soft foods six to eight times a day or every 30 to 60 minutes if consistent vomiting
  • Hospitalization may be required

Hyperglycemia

  • Hospitalization can cause you to need constant care and monitoring, even with high glucose. It may be short term or an actual sign.

*DKA versus HHS

  • Both can present hyperglycemia.
  • Both can need fluid and management
  • Both volume depletions
  • Both to correct electrolyte abnormalities
  • DKA:
  1. skipping insulin
  2. low insulin
  3. DM1 more often
  • HHS
  1. strokes
  2. Surgery
  3. Infections

DKA/HHS: Complications

  • Both cardiovascular (Hypovolemic Shock) Renal(Acute kidney failure)
  • A major goal will be TIGHTGLUCOSE CONTROL

Macrovascular Complications

  1. Most people who have diabetes will die from this
  2. Stroke
  3. Myocardial Infaction
  4. Angia
  5. amputation

Micro Complications:

  • ⅓ will get an ampuation
  • One can go blind
  • And will get neuropathy and angiopathy
  • Also will get oval discoclorations on the logs

Microvascular Considerations

  • Sensory
  • Autonomic-All body systems can be effect
  • Must have good foot care
  • Good hygiene Medical info needs to be with them

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