Of infection nonketotic hyperglycemic hyperosmolar

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Unformatted text preview: omatic; Hyperglycemia: dehydration; increased risk of infection; nonketotic hyperglycemic hyperosmolar coma nonketotic – Hypoglycemia may be atypical and can lead Hypoglycemia to injury to Lethargy or focal neurologic dysfunction Age-related decreases in regulatory function or an Age-related inability to report hypoglycemic symptoms inability Geriatric Considerations Geriatric Chronic complications – Heart and blood vessel disease – Foot problems Avoiding foot problems can be challenging from Avoiding frequent presence of orthopedic deformity and other common aging-related changes, as well as the decreased ability to perform appropriate foot care care – Eye disease – Kidney disease Goals of Treatment Goals Normalize Blood Glucose – <180 mg% postprandial, <126 mg% fasting Self monitor blood glucose routinely Normal blood glucose: 70-115 mg% Minimize hypoglycemic events – Keep HbA1c < 6.5% Reflects glucose level over past 2-3 months HbA1c increases 1% for each increase of 30mg% HbA1c in blood glucose in Goals of Treatment Goals Avoid Long-term Vascular and Avoid Neurological Complications Neurological – Glycosylated proteins, enzymes contribute to Glycosylated atherosclerotic processes: atherosclerotic retinopathy, nephropathy, MI, CVA, peripheral retinopathy, vascular disease vascular – Neurons don’’t require insulin, are exposed to t high intracellular glucose: high peripheral neuropathy, autonomic neuropathy Teaching, Teaching, Teaching Teaching, Blood glucose monitoring. Urine ketone monitoring. Drug onset, peak. Short and long term complications to Short monitor. monitor. When to call the provider, enter the When hospital. hospital. Diet and Exercise plan. Know the Difference HIGH HIGH Blood Sugar increased thirst and urination ketones in urine aching, weak heavy breathing nausea, vomiting fatigue cold sweats headache trembling pounding heart sleepiness personality change hunger LOW Blood Sugar Blood Case Study Donna is an 18-year-old high school student who began to experience weight loss despite a ravenous appetite and resulting increased dietary intake. She has to make frequent trips to the bathroom to urinate and has difficulty concentrating on her work because of fatigue. She drinks large volumes of coffee to help with a constant dry mouth and to combat her fatigue. At a clinic appointment, it was noted that Donna ’s weight has dropped from 140 pounds to 128 pounds. She is 5 feet 7 inches tall. Her urine specimen shows glycosuria and ketonuria. A chemstick blood glucose level is 412 mg/dl. Donna had eaten breakfast 3 hours before the chemstick blood test. Case Study 1. Considering Donna’s presenting history and physical data, what form of diabetes mellitus is indicated? 2. What are the physiologic mechanisms involved with the polydipsia, polyuria, and polyphagia in diabetes mellitus? 3. What immediate and long-term therapy will DK need to manage her disorder? 4. Donna will have to frequently monitor her own glucose levels to evaluate her...
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