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Unformatted text preview: omatic;
dehydration; increased risk of infection;
nonketotic hyperglycemic hyperosmolar coma
– Hypoglycemia may be atypical and can lead
Lethargy or focal neurologic dysfunction
Age-related decreases in regulatory function or an
Age-related inability to report hypoglycemic symptoms
inability Geriatric Considerations
– 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 – Eye disease
– Kidney disease Goals of Treatment
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
Avoid Long-term Vascular and
Avoid Neurological Complications
– Glycosylated proteins, enzymes contribute to
retinopathy, nephropathy, MI, CVA, peripheral
retinopathy, vascular disease
vascular – Neurons don’’t require insulin, are exposed to
high intracellular glucose:
peripheral neuropathy, autonomic neuropathy Teaching, Teaching, Teaching
Blood glucose monitoring.
Urine ketone monitoring.
Drug onset, peak.
Short and long term complications to
When to call the provider, enter the
Diet and Exercise plan. Know the Difference
ketones in urine
fatigue cold sweats
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
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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- Spring '14