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* anything over 120 is considered to be highDx BG > 250 mg/dLDKA BG > 330 mg/dLS/S:PolyuriaPolyphagiaPolydipsiaDehydrationFatigueFruity odor (breath – DKA)Kussmaul breathingWeight lossPoor wound healingHypoglycemia Management:oMechanism:
Endocrine NotesBrain secretes growth hormone (GH) which stimulates liverPancreas secretes glucagon which stimulates the liverThyroid secretes thyroxine which stimulates the liverAdrenals secretes epinephrine and medulla/cortex secrete cortisone which stimulates the liverGlucagon, GH, Thyroxine, Cortisone, Epinephrine stimulate the liver to produce glucose which raise blood sugar along with muscles producing glucose as wellThyroxine and epinephrine stimulate the muscles to produce glucoseoAny bloody sugar > 60 mg/dLoDangerous condition because glucose is major source of energy for the brainoCan occur:If too much insulin is givenNot enough food is eatenExcessive exerciseoS/S:Shaky (tremors)TachycardiaSweating (diaphoresis)Abnormal behaviorDizzinessHungryVisual changesWeaknessHAIrritabilitySeizure (convulsions)Loss of consciousnessConfusion Anxiety oTx: Start with simple carbohydrate (or glucagon, if severe), then complex carbs & proteins (cracker, peanut butter, milk)Mildly low: give carbohydrate (milk), protein snackModerately low: give fast sugar (fruit juice, frosting), then complex carb and proteinCOLD AND CLAMMY NEEDS MORE CANDY!!!!!!oGlucagon Emergency Kit:Severely low: BS < 90 mg/dL AND patient is unconscious and/or possibly having seizureTreatment: Place patient on sideMaintain and open airwayAdminister glucagon injection IM in the thighCall 911!Hyperglycemia Management:oBS > 120 mg/dL should be considered high
Endocrine NotesoDx BS > 250 mg/dLoS/S:PolydipsiaPolyuriaPolyphagiaDry skinVisual changesDrowsyNauseaKussmaul breathingoCheck urine for ketones if blood sugar is > 240 mg/dLIf negative, trace or small ketones are present then continue to drink clear sugar-free fluidsIf moderate – large ketones are present, extra fast acting insulin will need to be given oTx: IVF FluidInsulinPossible glucagonPossible oral medicationsExercise:oRegularlyoHypoglycemic riskoDon’t’ exercise aloneNursing diagnosis for DMoFluid volume deficit r/t blood glucose exceeding renal threshold causing glucose to spill into the urine creating an osmotic diuresis and electrolyte losses AEB thirst and increased appetiteoRisk for injury r/t hypoglycemiaoDeficient Knowledge (Diabetes Management) r/t care of child with newly diagnosed Diabetes MellitusEncourage Patients to:oMaintain regular clinical visitsoSelf-management Check blood sugars as ordered by physicianoTake all prescribed medicationsoEat a healthy well balanced dieto