Exam 2 Diabetes.docx - Med-Surg Exam 2 Diabetes Labs DM o Random or postprandial glucose > 200 o Fasting glucose > 126 o A1C > 6.5(life of RBC 120 days

Exam 2 Diabetes.docx - Med-Surg Exam 2 Diabetes Labs DM o...

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Med-Surg Exam 2 Diabetes Labs: DM: o Random or postprandial glucose > 200 o Fasting glucose > 126 o A1C > 6.5 (life of RBC 120 days) Prediabetes: o GTT or random glucose: 140-199 o Fasting glucose: 100-125 o A1C 5.7 to 6.4 o May be asymptomatic o Must teach about DM risk factors and prevention in this stage Hypoglycemia fasting: < 70 Normal K + : 3.5-5.0 o Inverse relationship with insulin DKA (low insulin) causes hyperkalemia o DKA is an acidotic state because K + is an acid Overuse of insulin causes hypokalemia Normal Na + : 135-145 o Inverse relationship with K + DM: DM1 aka “insulin dependent diabetes” DM1 can be latent with acute onset, often misdiagnosed as T2DM o Often in POC (Hispanics, African Americans, Asians) DM2 has a chronic, insidious onset Osmotic diuresis leads to FVD (see patho notes) Ketones from inability to get glucose into cells (with hypoglycemia) causes cause acid/base disturbances
o Ketones are fat byproducts from gluconeogenesis
Teaching to prevent long-term complications: Foot care Eye care (retinopathy, cataracts, blindness) Skin care Oral care (bleeding) Control of BP, lipids, and blood sugar Insulin/oral antidiabetics
Long-term DM 1 complications Infection, Impaired Senses, Hypoxia #1 cause of renal failure of blindness in US is DM High AIC (glycosylated Hgb) High A1C/ “3 P’s” long-term consequences: o Microangiopathy: thickened capillary basement membrane o Leads to diabetic nephropathy (CKD), retinopathy, peripheral neuropathy o Hypertension and kidney disease/dialysis (also used to be top causes of diabetes) o Hypoxia that leads to delayed healing, retinal destruction, angiogenesis, and diabetic neuropathy (usually feet and legs) o Tissue necrosis * Mr. Burns’ example: Pt had a pin that was stuck in the bottom of his foot. He didn’t know for a week—until his foot was swelling. Cause of numbness: diabetic neuropathy. o Macroangiopathy: large arteries affected o * Causes cataracts, CAD (“it’s beating up the vessels”), CVA, MI, CHF (collagen abnormality) Cataracts: clouding of eye lens , caused by accumulation of sorbitol and water in the lens o Ulcers (infection/gangrene of wounds) o Neuropathy: altered metabolism, ischemia that leads to degeneration/demyelination of nerve fibers o Numbness, tingling, impaired sensation o Muscle weakness/wasting o Cataracts from abnormal metabolism of glucose o Autonomic damage (e.g. neurogenic bladder— don’t know when to urinate)
Preventing complications:
Monitoring for long-term complications:
Low: Hypokalemia < 3.5 mEq/L
Causes: Severe Diarrhea, K+-wasting diuretics (loops diuretics), Excessive Aldosterone (spares Na+ &

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