HYPOGLYCEMIA

<60 

• Lightheadedness
• Headache, Hunger
• Anxiety, Irritability
• Strange or unusual feelings, Decreasing LOC
• Difficulty Thinking and Concentrating
• Blurred Vision
• Pallor, Cool Extremities
• Diaphoresis
• Tachycardia, Palpitations

HYPERGLYCEMIA

>200

• Confusion
• Dry Mucus membranes, Thirst, Fruity Breath
• N/V
• Skin that is warm, dry, and flushed with poor turgor
• Weakness, Lethargy
• Polyurea--->Oliguria
• Weak Pulse, Diminished Reflexes
• Kussmauls Respirations

DIABETES 1

Can be Autoimmune, triggered by virus destroying Pancreatic Beta Cells, Can be Genetic

• Weight Loss
• PPP (Polyuria, Polydipsia, Polyphagia)
• Enuresis
• Dry Skin
• Fatigue
• Headache

Treat with Nutrition Regimen, Insulin, Exercise, Psychosocial support

DIABETES 2

Can be Genetic (obesity), Due to high triglycerides (>250)

Inactivity, and Hypertension- leads to Insulin Intolerance

• Increased Insulin Resistance
• Persistent Hyperglycemia
• At Risk BMI > 85%

Treat with Diet, Exercise, Metformin or Insulin

DKA

> 200-330 Occurs in Insulin Deficiency and Illness

• Abdominal Pain, N/V
• Dehydration
• Tachy
• Increased Temp
• Elevated Ketones
• Acidosis <7.3, bicarb <15
• Glycosuria/Ketonuria
• Kussmauls Respirations

DKA TREATMENT

• Isotonic Fluids (0.9% NS) to correct dehydration
• R/F Cerebral Edema if rehydrated too quickly
• Short Acting (regular) Insulin Drip @ 0.1 units/kg/hr 
• Potassium (as insulin treatment starts to lower serum K levels) but make sure renal function is confirmed first.

HYPOGLYCEMIA TREATMENT

• Icing in a tube
• Glucose tabs
• Glucagon Shot (if unconscious)
• Sugar (Juice) first, Protein/Sugar (PB, Milk) second, Complex Carb third 

DIABETES

Nursing Management and Education 

• Plan meals with consideration to activity and insulin schedule
• Teach S/S of hypo/hyperglycemia
• Count Carbs
• Encourage low fat, low carb diet management
• Artificial sweeteners in moderation
• Decrease emotional stress

HUMAN GROWTH HORMONE DEFICIENCY

• Growth Hormone Replacement Therapy
• Daily (at least 6/7 days) Subcutaneous Injections
• Stop when Epiphyseal Plate closes in Long Bone

Insulin Onset Peak and Duration

• Rapid Acting LISPRO 15-30 min/30-2.5 hrs/3-6 hrs
• Short Acting REGULAR 30-60 mins/1-5 hrs/6-10 hrs
• Intermediate NPH 1-2 hrs/ 6-14 hrs/16-24 hrs
• Long Acting GLARGINE 70 mins/ None/ 24 hrs