Diabetes Complications

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Diabetes Complications

• Dr. Kathleen Ethridge
• Northeast Texas Community College

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DKA

• Diabetic Ketoacidosis
• Most serious complication in Type 1 diabetes

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Precipitating Causes

• Not enough insulin
• Skipping insulin
• Stress, trauma
• Insulin resistance

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Pathophysiology of DKA

• See chart
• Ketosis
• Dehydration
• Electrolyte imbalance

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Symptoms of DKA

• Abdominal pain
• Anorexia
• Dehydration
• Fuity breath
• Kussmauls
• Change LOC
• Hypotension
• NV

• Polyuria
• Somnolence
• Tachycardia
• Thirst
• Visual disturbances
• Warm, dry skin
• Weakness
• Wt. loss

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Assessment DKA

• Hyperglycemia
• Hyperosmolality
• Dehydration
• Electrolyte imbalances
• Metabolic acidosis
• Hypoglycemia
• Fluid overload

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Intervention

• Rehydrate
• Reverse shock
• Give Potassium
• Corret pH
• Give insulin

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Critical Monitoring

• Rehydration
• I O, Daily Weight
• Skin turgor, LOC, VS
• CVP measurement
• Auscultation of lungs

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IV Fluids in DKA

• Hour 1
• N/S or Ringers 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

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Potassium Replacement in DKA

• Look at EKG
• Replacement is based on plasma potassium level
• Recheck potassium q 2 hours

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Correct pH/Give Insulin

• Give IV Insulin
• Give Regular Insulin only
• Initial bolus IV (0.15u/kg)
• Then Regular Insulin IV drip

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HHNKHyperglycemic, Hyperosmolar Noketotic
Syndrome

• Most commonly occurs in older adults with Type II
  diabetes
• Always look for precipitating factors

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Factors Associated with HHNK

• Drugs
• Procedures
• Chronic illness
• Acute illness

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Four Major Clinical Features

• Severe hyperglycemia
• No or slight ketosis
• Profound dehydration
• Hyperosmolality

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Treatment

• Similar to DKA
• Find underlying cause

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Hypoglycemia

• Also known as insulin reaction or hypoglycemic
  reaction

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Risk Factors

• Overdose of insulin
• Omitting a meal
• Overexertion
• Nausea and vomiting
• Alcohol intake

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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

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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

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Acute Complications of Diabetes

• Compare
• DKA
• HHNK
• Hypoglycemia
• see chart for comparison

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Other Complications

• Hypoglycemic Unawareness
• Somogyi Phenomenon
• Dawn Phenomenon

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Chronic Complications

• Macrovascular Complications
• Microvascular Complications
• Neuropathic Complications
• Mixed

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Foot Infections with Diabetes

• Inspection
• Footwear
• Foot Care

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Microvascular Complications

• Retinopathy
• Nephropathy

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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

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Neuropathy

• Mononeuropathy
• Polyneuropathy

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Diabetic Client and Surgery

• Preoperative care
• Intraoperative care
• Postoperative care

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Sick Days and Diabetes

• Individualized plan
• Monitoring
• glucose levels
• ketones
• insulin
• nutrition
• fluids
• Know when to call the Doctor

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Children with Diabetes
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Vacation, Travel and Diabetes