o Polyphagia Fats and proteins are used for energy and depleted triggering hunger. DKA Treatment Admission to PICU Must be on cardiac monitor due to electrolyte disturbances Hourly blood glucose checks Insulin drip titrated to bring down glucose slowly o Do not want to drop glucose more than 100 in one hour to avoid cerebral edema o IV Insulin – REGULAR ONLY o IV Fluids – NO GLUCOSE when first starting After a few hours – add glucose too Careful administration of IVFs containing specific amounts of potassium, sodium, glucose Strict I&O, monitor voids and check for glucose, ketones o Diagnostic Testing used in DM Blood Glucose Tests Indicative of DM Type 1 Diagnosis: Random: >200 mg/dl Fasting: >125 mg/dl
Hemoglobin A1c Amount of glucose that binds to hemoglobin Assesses glucose control over the past 60-90 days In non-diabetic , level will be less than 5.9 In diabetic, want level around 7 or less Higher the number, the poorer the control o Type 1 DM: Management DKA can occur anytime that DM is not well managed Maintain normal glucose levels through a balance of eating enough glucose and administering enough insulin Important to balance, nutrition, medications, and exercise Nutrition Carbohydrates o Main source of energy o 100% becomes SUGAR in blood o Peak in ONE hour and out of blood in TWO hours o Very important in managing diabetes o Fruit and Fruit Juice contain a HIGH AMOUNT of sugar (fructose) Proteins o Helps body build tissues, immunity, and wound healing o Some will be converted to sugar (if body needs it) o Stays in blood longer (THREE hours) Fats o Slows digestion o Absorbs A, D, E, K o Little direct effect on blood sugar o Delays digestion so carb effect on blood sugar is delayed Counting Carbs Number of carbs determines how many units of insulin are need Blood glucose also plays into how much insulin is administered USUALLY, 10 or 15 grams of carbs is considered a serving and that amount gets ONE unit of insulin Round to nearest unit when calculating carbs and determining how many units of insulin to draw up in a syringe or pen Medication Insulin is used to treat Type 1 DM Rapid Acting Short-acting (REGULAR) Intermediated Acting Long-Ac NovoLog Humalog Regular insulin NPH Lente Lantus Reaches blood in 15 min Reaches blood in 30 min Reaches blood in 2-6 hrs Reaches Peaks in 30-90 min Peaks 2-4 hours Peaks 4-14 hrs None (s Lasts up to 5 hours Lasts 4-8 hours Lasts 14-20 hours Lasts 20 Administration Options Insulin via pump, pen, or syringe Regular – ONLY ONE that can be admin IV Choose syringe that allows most precise draw up Nursing Considerations: Insulin Admin Monitor for signs of hypoglycemia Rotate injection sites (including when using pump) to avoid lipodystrophy Use smallest insulin syringe appropriate
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- Spring '17
- Cortisol, Hemoglobin, Bone marrow