Diabetes Complications

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

Children with Diabetes

Vacation, Travel and Diabetes

Diabetes Complications