Complications of Diabetes Care
-Hypoglycemia Definition
- Hypoglycemia is defined as a blood glucose level <70 mg/dl
- Caused by imbalance of food, exercise, and insulin
Complications of Diabetes Care
-Risk Factors for Hypoglycemia
- Elderly
- Tight glucose control
- Renal insufficiency or ESRD
- Multiple DM medications
- T1DM and Insulin-dependent T2DM
- Previous Hypoglycemia
-Beta Blockers can CAUSE or exacerbate HYPOGLYCEMIA in some individuals.
—Monitor BS closely
Complications of Diabetes Care
-Symptoms of Hypoglycemia **
Mild Symptoms Include: (No Mental status change in Mild symptoms) (SELF-MANAGE)
- Headache
- Sweating
- Increased HR and feeling anxious and irritable
- Trembling
- Weakness or tiredness
Moderate Symptoms: (Decrease Thinking, Mental Fog.. Mental status changes)
-Individuals with Mild or MODERATE Hypoglycemia can SELF MANAGE
Severe Hypoglycemia (COMA, UNABLE TO SELF MANAGE)**** -Need assistance
Hypoglycemia Treatment
-15-15 rule
Preferred treatment:
- 15 G of GLUCOSE for the conscious individual
- 15 G rapid-acting carbohydrate
- Check BS level in 15 minutes
If BG is still <70, repeat 15 G of carbohydrate
-If normal, eat a meal or snack to prevent recurrence
Hypoglycemia Treatment
-Examples of 15 G of Glucose?
- 4 ounces of regular soda or juice, glucose gel, glucose tablets
- 1 tablespoon of sugar, honey, or corn syrup
- Hard candies, jellybeans, or gumdrops
Hypoglycemia Treatment
-Severe Treatment?
If Patient can swallow, give 45 g of simple carbohydrates
If patient is unconscious
-GLUCAGON IM injection <54 mg/dL
Call 911 if glucagon is unavailable
-Do not force food or drink
D50 1/2 ampule can be given IV for patients in severe hypoglycemia per paramedics or ER.
Hypoglycemia S/S
-Patient Education
Educate patient and family
- Recognition of signs and symptoms of hypoglycemia
- appropriate treatment
- Wear medical ID bracelet
DOCUMENT EDUCATION GIVEN in clinic
Complications of Diabetes Care
-DKA characteristics?
- Hyperglycemia
- Hyperketonemia
- Metabolic Acidosis
Caused by inadequate insulin treatment or non-adherence to therapy
Complications of Diabetes Care
-DKA Dx Criteria
- BS greater than 250
- PH <7.3
- Bicarb level 18 meq/L or less
- Elevated serum ketones
- Dehydration
- Insulin deficiency (precipitating factor)
Complications of Diabetes Care
-DKA Causes
- New onset type 1 diabetes
- Non-adherence to insulin
- Infection, Illness, major surgery
Complications of Diabetes Care
-DKA symptoms
- Rapid development of abdominal pain, nausea & vomiting
- Kussmaul respirations
- Dehydration, excessive thirst, and frequent urination
Complications of Diabetes Care
-DKA Physical Exam
- Fruity odor (Acetone breath)
- Tachycardia
- Hypotension
- Changes in consciousness
Complications of Diabetes Care
-DKA Lab Assessments
- ABG’s
- Electrolytes
- Glucose
- Anion Gap
- Beta-hydroxybutyrate (serum ketones)
ER Inpatient Management
Complications of Diabetes Care
-Management of DKA
- Fluid resuscitation
- IV insulin Administration
- Electrolyte monitoring and replacement
- Treatment of underlying illness
- Usually managed in the ICU
Complications of Diabetes
-Microvascular Complications
- Diabetic Retinopathy
- Diabetic Nephropathy
- Diabetic Neuropathy
Occurs when DM is untreated or poorly managed
Complications of Diabetes (Microvascular Complications
-Diabetic Retinopathy
- Affects MOST patients with T1DM; and 21% of patients with T2DM
- LEADING cause of NEW-ONSET BLINDNESS
- Loss of vision if untreated
- Need annual ophthalmology screening
Complications of Diabetes (Microvascular Complications)
-Diabetic Retinopathy Screening?
- Annual screening by an ophthalmologist
- At Dx of T2DM
- 5 years after Dx of T1DM (Due to earlier onset)
Complications of Diabetes (Microvascular Complications)
-Diabetic Nephropathy
- Most common cause of ESRD
- Second leading cause of death
- 60% of patients require dialysis or transplantation
- MICROALBUMINURIA earliest indication
Complications of Diabetes (Microvascular Complications)
-Diabetic Nephropathy Characteristics
- Proteinuria
- Hypertension
- Edema
- Renal Insufficiency
Complications of Diabetes (Microvascular Complications)
-Earliest Indicator of Diabetic Nephropathy?
- Microalbuminuria
Complications of Diabetes (Microvascular Complications)
-Testing for Microalbuminuria?
- Test annually at diagnosis of T2DM
2. Test 5 years after diagnosis of T1DM
Complications of Diabetes (Microvascular Complications)
-When Nephrology Consult is needed for Diabetic Nephropathy
- Microalbuminuria (30-300 mg/24hrs)
- Overt albuminuria >2mg/dl or
- Decreased GFR (<50ml/min)
Complications of Diabetes (Microvascular Complications)
-Diabetic Nephropathy Treatment?
Treat with:
1. ACE inhibitor (One side effect is cough)
OR
2. ARB
Not both, due to similar class of medication
These medications are shown to delay dz progression to proteinuria
Complications of Diabetes (Microvascular Complications)
-Diabetic Neuropathy
- Affects 60-70% of patients
- Peripheral neuropathy is most common neuropathic complication
- Starts in feet and legs and is characterized by burning, tingling, prickling
- Worse at night
- Muscle weakness and gait affected.
