1. Diabetes August 2012

2. Type I or Type II Type IType II Juvenile diabetesMost common form of diabetes Usually diagnosed in children and young adults Millions diagnosed and many unaware they have it Body will not produce insulinEither the body does not produce enough insulin or the cells ignore the insulin Only 5% of diabetics are a type I

3. Symptoms – Type I Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue and irritability

4. Symptoms – Type II Any of the type I symptoms Frequent infections Blurred vision Cuts and bruises that are slow to heal Tingling or numbness in the hands or feet Recurring skin, gum or bladder infections

5. Prevention Type II can be prevented or delayed Lead a healthy lifestyle Change your diet Increase your physical activity Maintain a health weight

6. Myths Diabetes is not that serious of a disease If you are over weight you will eventually develop type II diabetes Eating too much sugar can cause diabetes People with diabetes must eat special foods People with diabetes cannot eat carbs or sugars It is ok to eat as much fruit as you want because it is healthy

7. Diabetic Ketoacidosis (DKA) Insulin deficiency and excessive stress hormone Typically in Type I but can be in Type II Elevated glucose promotes osmotic diuresis and dehydration

8. Stress hormones stimulate free fatty acids which cause a release of ketones Causes decreased myocardial contractility and cerebral function Usually brought on by infection and stress

9. Interventions Gradually return to normal metabolic balances FSBS and notify the MD of the results 2 large bore IV’s NS at a rate of 1 liter per hour O2 and maintain ABC’s Insulin drip per protocol Monitor patient every 5-15 minutes until stable Closely monitor intake and output Cardiac monitor

10. Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC) Occurs in type II Profound dehydration from elevated glucose and osmotic diuresis No ketones-not enough insulin to start the process Can be caused by infection, stroke or sepsis High mortality rates

11. Interventions FSBS and notify the MD of the results May require intubation 2 large bore IV’s NS 1 liter over 1 hour Insulin drip per protocol Monitor the patient every 5-15 minutes until stable Closely monitor the intake and output Cardiac monitor

12. Hyperglycemia Serum glucose drops below 50 Below 35-the brain cannot adequately extract oxygen Results in hypoxia and eventually coma Any person with an altered level of consciousness should be considered to have low glucose until proven otherwise

13. Interventions O2 and maintain ABC’s FSBS and notify MD of results If alert and oriented x3, give oral glucose solutions (oj, milk, etc. ) Establish IV ½ to 1 amp of 50% dextrose (D50) per MD’s orders Monitor the mental status closely Monitor the FSBS every 15-30 minutes Order a meal tray STAT Cardiac Monitor

14. References American Diabetic Association Emergency Nursing Core Curriculum, ENA Fundamentals of Nursing, Potter and Perry