Complications of Diabetes

Hypoglycemia

• Definition: Blood glucose level under 70 mg/dL.
• Causes:
  • Excess insulin.
  • Skipping meals or reduced food intake.
  • Exercise.
  • Excess alcohol.
• Signs and Symptoms:
  • Hunger, irritability, confusion.
  • Diaphoresis, headache, shakiness.
  • Blurred vision, pale and cool skin.
  • Decreased consciousness, potentially leading to coma.
  • Mnemonic: "If the skin is cold and clammy, you need some candy."
• Nursing Care:
  • Conscious patients: Administer 15 grams of a readily absorbed carbohydrate (e.g., juice, soda, or milk) and recheck blood glucose after 15 minutes.
  • Unconscious patients: Administer glucagon IM or subcutaneously. If no consciousness after 10 minutes, repeat glucagon.
  • Note: Glucagon may cause nausea and vomiting.

Diabetic Ketoacidosis (DKA)

• Description: Life-threatening with increased blood glucose and ketones in blood/urine.
• Common In: Type 1 diabetics.
• Onset: Rapid.
• Risk Factors:
  • Infection or illness.
  • Stress.
  • Untreated or undiagnosed Type 1 diabetes.
• Signs and Symptoms:
  • Hyperglycemia signs (three Ps: polydipsia, polyphagia, polyuria).
  • Weight loss, fruity breath odor, Kussmaul respirations.
  • Dehydration.
• Lab Indicators:
  • Blood glucose > 300
  • Ketones in blood and urine.
  • Metabolic acidosis present.
  • Hyperkalemia.
  • Mnemonic: "D-K-A" (monitor potassium, K, levels closely).

Hyperglycemic Hyperosmolar State (HHS)

• Description: High glucose levels with severe dehydration.
• Common In: Type 2 diabetics.
• Onset: Gradual.
• Risk Factors:
  • Older age, inadequate fluid intake.
  • Decreased kidney function.
  • Infection and stress.
• Signs and Symptoms:
  • Hyperglycemia symptoms.
  • Dehydration symptoms like hypotension, weak pulse.
• Lab Indicators:
  • Blood glucose > 600
  • No ketones.
  • No metabolic acidosis.

Treatment of DKA and HHS

• Underlying Causes: Identify and treat infections.
• Fluids & Insulin: Administer IV fluids and insulin.
• Blood Glucose Monitoring: Hourly checks, aim to bring under 200.
• Metabolic Acidosis: Administer bicarbonate if present in DKA.
• Potassium Levels: Monitor closely.
  • Initial hyperkalemia in DKA.
  • Insulin administration may lead to hypokalemia.

Chronic Complications of Diabetes

• Education: Important for prevention and management.
• Potential Complications:
  • Cardiovascular disease (myocardial infarction, stroke).
  • Diabetic neuropathy (neuropathic pain, foot injury/infection).
  • Nephropathy (kidney damage).
  • Retinopathy (eye damage, blindness).
  • Gastroparesis (impaired digestion).
  • Dental issues (tooth decay, gum disease).
  • Sexual dysfunction.