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36 Cards in this Set
- Front
- Back
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hypoglycemia is a blood sugar
< 80 <60 <50 <40 |
< 50
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in a normal pt. insulin secretion shuts off at what blood glucose level?
<150 <100 <90 <80 |
at < 80
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when the blood sugar drops to 65-70 what does the body do?
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If the level falls between 65-70 glucoreceptors in the hypothalamus cause the release of glucagon and epinephrine
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what happens in the body when blood glucose drops to 60-65
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Growth hormone secretion increases when plasma glucose concentration falls to 60-65
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what happens within the body when glucose drops to 60 or below?
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Cortisol is increased when plasma glucose concentration falls below 60
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how does the diagnosis of type 1 dm affect hypoglycemia?
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Hypoglycemia is increased due to impairment of the normal counter-regulatory response as well as the emphasis on tight glycemic control
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how does the diagnosis of type 2 dm affect hypoglycemia?
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Much less common in Type II
Most often due to the use of Sulfonylurea |
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what are some risk factors for hypoglycemia?
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Type I DM
Unstable DM Neurologic deficits – inability to recognize symptoms, inconsistent caloric intake, delayed meals, exercise without attention to glucose levels History of hypoglycemia ETOH use |
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what medications can cause hypoglycemia?
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Nonselective Beta blockers
ACEI |
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what GI problems can cause hypoglycemia?
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prolonged n/v
pancrease disease post gastrectomy |
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s/s of hypoglycemia of BS <70?
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sweating
fatigue anxiety palpitations hunger tremor nausea tachycardia |
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s/s of hypoglycemia of BS <50?
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fatigue
h/a visual disturbance drowsiness difficulty speaking dizziness |
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list more common meds that are associated with hypoglycemia?
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Steroids
Tylenol Quinine Pentamidine – ABX Salicylate MAOI Sulfa Insulin Allopurinol Hypo-glycemics ACEI Beta blockers |
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what are common physical exam findings in a pt with hypoglycemia?
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Pale, diaphoretic, irritable, change in mental status
VS – tachycardia Neuro – tremor, slurred speech, decreased coordination, seizures |
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what is the treatment of mild hypoglycemia?
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15gm of simple acting carbohydrate by mouth (4 oz. OJ)
Stop activity Repeat glucose in 10-15 minutes If still < 60 give additional 15 gms In 30 minutes eat a protein rich snack |
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what is the tx of moderate hypoglycemia?
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Consume 15-30 gms initially
Follow same protocol as for mild |
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what is the tx of severe hypoglycemia?
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If patient can swallow, give 30-45 gm of CHO
If unresponsive, 0.5 – 1 glucagon SQ or IM Patient should recover/improve in 10-15 minutes but may have nausea for 60-90 minutes May also treat unresponsive patients with 25-50 gms of 50% glucose IV – if no improvement in 15 minutes then repeat 50ml 50% glucose IV |
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what is the pathophysiology of hyperglycemia?
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Increased glycemia may be precipitated by illness, infection, meds, MI or other stressors.
It develops because the beta cells of the pancreas are dysfunctional |
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hyperglycemia in type I DM is due to?
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due to beta cell failure and lack of insulin production
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hyperglycemia in type II DM is due to?
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due to the pancreas’ inability to produce enough insulin and the body’s inability to use insulin efficiently
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__ is defined as profound hyperglycemia associated with osmotic diuresis, dehydration and acidosis.
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diabetic ketoacidosis
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__ is defined as obesity, elevated triglycerides, decreased HDL and HTN
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metabolic syndrome
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is there a genetic predisposition for type 1 or type 2 dm?
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type 2
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what endocrinopaties put pt's at risk for hyperglycemia?
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Cushing’s disease, acromegaly, pheochromocytoma, hyperthyroidism and PCOS
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tumors that secrete __ or __ put pt's at risk for hyperglycemia.
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glucagon or somatostatin
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__% of women with gestational diabetes progresses to type 2 dm.
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40 %
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what is the classic triad of dm?
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polyuria
polydipsia polyphagia |
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sugar spills into the urine at what level?
-250 -200 -180 -150 |
180
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what are complications of dm?
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wounds that won't heal
frequent yeast infections recent infxns or surgery |
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what does etoh due to the blood sugar?
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raises it
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what are the vital signs in someone with hyperglycemia?
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elevated or decreased temp
tachycardia & shallow respirations Hypotension or orthostasis |
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what would the pt's breath smell like with DKA?
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ketotic/fruity in hyperglycemia
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will the pt be "wet" or "dry" if they are hyperglycemic?
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dry
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Kussmaul respirations is indicative of ?
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DKA
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what should be checked at every visit in a dm pt?
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check their feet
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what is important in regards to vision in a dm pt?
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regular fundoscopic areas, check for retinopathy, vascular changes, AV nicking
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