Diabetes Assessment
- Juvenile Onset
- Absent Insulin Production
- Ketosis Prone
- Adult Onset
- Insulin Resistance
- Obesity
- Onset During Pregnancy
- Glucose Intolerance
- Retinopathy
- Peripheral Vascular Disease
- Nephropathy
- Neuropathy
Oral Glucose Tolerance Test (OGTT)
- Used for Diabetes Screening
- Fasting State
- Baseline
- Normal < 100 mg/dL
- 30 and 60 Minutes
- Normal < 200 mg/dL
- 120 Minutes
- Normal < 140 mg/dL
Diabetic Ketoacidosis (DKA) Signs and Symptoms
- Kussmaul respirations
- Dehydration
- Abdominal Pain
- Nausea/vomiting
- Psychosis
- Fruity breath Odor
Diabetic Ketoacidosis (DKA) Diagnosis and Labs
- Blood glucose Increased > 250 mg/dL
- Anion gap metabolic acidosis
- Decreased pH < 7.3
- Decreased serum bicarbonate < 18
- Plasma ketones
- Hyperkalemia
Diabetic Ketoacidosis (DKA) Treatment
- IV Normal Saline
- Regular Insulin Drip
- Potassium (K+)
- Glucose
- Treat Underlying Cause
- Venous pH
- Serum Bicarbonate (HCO3)
Diabetic Glomerulonephropathy
- Nonenzymatic Glycosylation of Glomerular Basement Membrane
- Nonenzymatic Glycosylation of Arterioles
- Hyperfiltration
- Increased GFR
- Hyaline Arteriolosclerosis
- Mesangial Expansion
- Type IV Collagen Deposition
- Kimmelstiel Wilson Lesions
- Nephrotic
Dawn Phenomenon
- Increased Hormone Production
- Hyperglycemia Upon Awakening
- Long-Acting Evening Insulin
- Change Administration Times
- Insulin Pump
- Closely Monitor Glucose Levels
- Between 2-6AM
- Limit Carbohydrates Before Bedtime
Corrected Na+ for Hyperglycemia
- [(Glucose-100) * 0.016 ] + Na+
- Glucose-100
- Multiply * 0.016
- Add Na+
Diabetes Education
- Self-Monitoring (Blood Glucose)
- SubQ Injection Technique
- Lifestyle Changes
- Symptoms of Hyperglycemia and Hypoglycemia
- Sick Day Care
- Foot Care
- Exercise Therapy
- Medication
Metabolic Syndrome
- Dyslipidemia
- Central Obesity
- Insulin Resistance
- Hypertension
- Increased C-Reactive Protein (CRP)
- Increased Fibrinogen
- Increased Risk Cardiovascular Disease
Gestational Diabetes
- Usually Asymptomatic
- Fetal Macrosomia
- Polyhydramnios
- Glucose Intolerance After 24 Weeks Gestation
- 3-hr 100g Glucose Tolerance Test
- Diet and Exercise
- Close Glucose Monitoring
- Insulin
- Ultrasound (or Nonstress Test (NST))
- Delivery
Acanthosis Nigricans
- Endocrine Disorders
- Diabetes Mellitus
- Obesity
- Malignancy
- Velvety Plaques
- Dark, Thickened Flexural Areas
- Hyperkeratosis with Melanocytes
- Treat Underlying Disorder
Hyperosmolar Hyperglycemic State
- Insulin Present
- Increased Serum Osmolality
- Glucose >600 mg/dL
- No Significant Acidosis or Ketosis
- Severe Dehydration
- Altered Neurological Status
- Tachycardia and Hypotension
- IV Fluids
- Insulin
- Treat Underlying Disorder
Nonproliferative Diabetic Retinopathy
- Increased Capillary Permeability and Leakage
- Often Asymptomatic
- Retinal Microaneurysms
- Flame-shaped Hemorrhages
- Cotton Wool Spots
- Hard Exudates
- Macular Edema
- Treat Diabetes
- Laser Photocoagulation
- Bevacizumab
Pregnant Diabetic Patient Interventions
- Increase Insulin then Decrease
- Metformin
- Nutrition
- Exercise
- Increase Insulin
- More Likely to Develop Hypoglycemia than Hyperglycemia
- Double or Quadruple Insulin
- Early Delivery
- Drastically Decrease Insulin
- Monitor Neonate for Hypoglycemia
Diabetes Interventions
- Early Diagnosis
- Insulin
- Oral Hypoglycemics
- Glucose Monitoring
- Routine Exercise
- Diabetic Diet
- Monitor for Complications
- Insulin Therapy
- Diabetic Ketoacidosis (DKA)
Proliferative Diabetic Retinopathy
- Angiogenesis
- Increased VEGF
- Asymptomatic Until Late-stage
- Vitreous Hemorrhage
- Retinal Detachment
- Glaucoma
- Findings of Nonproliferative Diabetic Retinopathy
- Laser Photocoagulation
- Surgery
- Bevacizumab