Diabetes Complications

1. Diabetes Complications Dr. Kathleen Ethridge Northeast Texas Community College

2. DKA • Diabetic Ketoacidosis • Most serious complication in Type 1 diabetes

3. Precipitating Causes • Not enough insulin • Skipping insulin • Stress, trauma • Insulin resistance

4. Pathophysiology of DKA • See chart • Ketosis • Dehydration • Electrolyte imbalance

5. 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

6. Assessment DKA • Hyperglycemia • Hyperosmolality • Dehydration • Electrolyte imbalances • Metabolic acidosis • Hypoglycemia • Fluid overload

7. Intervention • Rehydrate • Reverse shock • Give Potassium • Corret pH • Give insulin

8. Critical Monitoring • Rehydration • I & O, Daily Weight • Skin turgor, LOC, VS • CVP measurement • Auscultation of lungs

9. 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

10. Potassium Replacement in DKA • Look at EKG • Replacement is based on plasma potassium level • Recheck potassium q 2 hours

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

12. HHNKHyperglycemic, Hyperosmolar Noketotic Syndrome • Most commonly occurs in older adults with Type II diabetes • Always look for precipitating factors

13. Factors Associated with HHNK • Drugs • Procedures • Chronic illness • Acute illness

14. Four Major Clinical Features • Severe hyperglycemia • No or slight ketosis • Profound dehydration • Hyperosmolality

15. Treatment • Similar to DKA • Find underlying cause

16. Hypoglycemia • Also known as insulin reaction or hypoglycemic reaction

17. Risk Factors • Overdose of insulin • Omitting a meal • Overexertion • Nausea and vomiting • Alcohol intake

18. 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

19. 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

20. Acute Complications of Diabetes • Compare • DKA • HHNK • Hypoglycemia • see chart for comparison

21. Other Complications • Hypoglycemic Unawareness • Somogyi Phenomenon • Dawn Phenomenon

22. Chronic Complications • Macrovascular Complications • Microvascular Complications • Neuropathic Complications • Mixed

23. Foot Infections with Diabetes • Inspection • Footwear • Foot Care

24. Microvascular Complications • Retinopathy • Nephropathy

25. 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

26. Neuropathy • Mononeuropathy • Polyneuropathy

27. Diabetic Client and Surgery • Preoperative care • Intraoperative care • Postoperative care

28. Sick Days and Diabetes • Individualized plan • Monitoring • glucose levels • ketones • insulin • nutrition • fluids • Know when to call the Doctor

29. Children with Diabetes

30. Vacation, Travel and Diabetes