NCLEX-RN Flashcards: Diabetes Nursing, Blood Glucose, Insulin Administration

Diabetic ketoacidosis, or DKA, presents with hyperglycemia above 250, Kussmaul respirations which are deep and rapid, fruity acetone breath, nausea, vomiting, abdominal pain, dehydration, altered consciousness, and a slow onset over hours. Hypoglycemia, below 70, presents with a rapid onset of sweating, tremor, tachycardia, hunger, anxiety, confusion, slurred speech, seizures, and loss of consciousness. DKA is treated with intravenous insulin, fluids, and electrolyte replacement.

Rotate injection sites among the abdomen, thighs, upper arms, and buttocks to prevent lipodystrophy, which is thickening or wasting of tissue from repeated injections in the same spot. The abdomen provides the fastest and most consistent absorption. Do not inject within two inches of the umbilicus. Inject at a 90-degree angle for most patients. Do not massage the injection site. Rapid-acting insulin should be given within 15 minutes before meals.

Type 1 diabetes results from autoimmune destruction of pancreatic beta cells, typically diagnosed in childhood or young adulthood. Patients are always insulin-dependent and at risk for diabetic ketoacidosis. They are usually thin at diagnosis. Type 2 diabetes results from insulin resistance and progressive beta cell dysfunction, typically diagnosed in adults over 40 though increasingly in younger people. Patients are often overweight. Type 2 initially responds to lifestyle changes and oral medications but many eventually need insulin.

Hemoglobin A1C, also called glycosylated hemoglobin, measures the percentage of hemoglobin with glucose attached, reflecting average blood glucose control over the past two to three months, which matches the lifespan of red blood cells. The target A1C for most diabetic adults is below 7 percent, which correlates with an estimated average glucose of about 154 milligrams per deciliter. An A1C of 6.5 percent or higher on two separate tests is diagnostic for diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes.

The Somogyi effect is rebound hyperglycemia that occurs when a nocturnal hypoglycemic episode triggers counter-regulatory hormones like glucagon, cortisol, and epinephrine, causing blood glucose to spike by morning. Treatment involves reducing the evening insulin dose or adding a bedtime snack. The dawn phenomenon is early-morning hyperglycemia caused by the normal physiological release of growth hormone and cortisol between 4 and 8 AM, without preceding hypoglycemia. Treatment involves adjusting the timing or dose of evening insulin.

Sick day management teaches diabetic patients to maintain adequate fluid intake, continue taking insulin or diabetes medications even if unable to eat because illness raises blood glucose, monitor blood glucose every four hours, test urine for ketones if type 1 or if blood glucose exceeds 300, eat small frequent meals of easily tolerated carbohydrates, and contact the healthcare provider if blood glucose remains above 240 despite extra insulin, ketones are moderate or large, vomiting persists and prevents oral intake, or fever exceeds 101 degrees.

Hyperosmolar hyperglycemic state, or HHS, is a life-threatening complication of type 2 diabetes characterized by extremely high blood glucose, typically above 600 milligrams per deciliter, severe dehydration, and hyperosmolarity without significant ketoacidosis. It develops gradually over days to weeks, often triggered by infection, medication noncompliance, or acute illness. Signs include profound dehydration, altered mental status progressing to coma, seizures, tachycardia, and hypotension. ---