okay guys so we are picking back up with diabetes so we have definition of diabetes that is a sustained hyperglycemia so it's elevated glucose levels so serum glucose above normal that is not a side effect of something else medications etc so this would be an elevated blood sugar that is not the cause of anything else such as medications or um any type of other disease process or anything else okay so classic symptoms are the three p's i'm gonna flip here [Music] okay so the three p's that you need to be aware of is polyphagia polyuria and polydipsia so you want to remember what all of those mean okay so with uh on your outline if you're going by your outline in order polyphagia is or is uh excessive eating polyuria is excessive urination and polydipsia is excessive thirst so you should be making sure you uh mark those on your outline so you know what all of those mean okay and then you can just refer to the slide to look over all the symptomology that can occur especially with the type 1 diabetic we're going to talk about the differences between type 1 and type 2 here in a minute so coming back here so some of the other classic symptoms you may see that which you also saw on the slide is dehydration weight loss and glucosuria glucosuria is glucose in the urine type 1 diabetes so if we say what is type 1 diabetes i'm going to go ahead and flip to the slide okay so type 1 diabetes the causes can be autoimmune it can be hereditary it can even be viral meaning a viral cause such as like congenital rubella syndrome um this would be something that is maybe the result of a maternal infection so mommy contracted an infection while pregnant so if they contracted the rubella virus during pregnancy otherwise known as german measles that could also cause type 1 diabetes so what is diabetes what causes diabetes so there's three things going on here okay one of three things is happening so either the body has the inability to produce insulin that would be type 1 or the body has the inability to produce adequate amounts of insulin that would be type 2 or the body becomes what's called insulin resistance so it's resistant to insulin that is also another type 2 okay so those are the three things that could be occurring with the patient who is diabetic so this just kind of goes to talk about um the beta cells within the pancreas how they produce the insulin um and this is just a graphic for you to look at and if for those of you who are visual learners so going back to the outline um so i the pancreas does not either produce enough insulin it might require insulin replacement and then there's also the possibility of diabetic ketoacidosis so otherwise abbreviated and known as dka that's also possible with type 1 diabetics so this is where the glucose levels are actually high and the body is actually producing ketones so we produce ketones due to lipolysis so when that breakdown of fat occurs the byproduct of that is ketones so we would call that dka or diabetic ketoacidosis diabetic type 2 this can be heredity obesity pancreatitis all of these are causative factors the pancreas still does produce some insulin but generally not enough to actually control glucose levels and then the patient may even eventually require insulin and these types of patients are less prone to dka although they can still um go into a dka they're they're just less prone to it so diabetic ketoacidosis it's a little bit blurry but hopefully you can see that okay and make sure you check out your slide so um again in kind of further explaining diabetic ketoacidosis or dka there's not enough circulating insulin to control glucose levels so the patient becomes hyperglycemics that's what you're seeing here in this picture um we use fat as a source of energy right but that breakdown of fat is called lipolysis and again just to reiterate already mentioned this the byproduct of lipolysis is ketones and so the patient can become acidotic or go into acidosis so it would be a metabolic acidosis and then we have severe dehydration and electrolyte imbalance that actually occurs and it's particularly with potassium you'll see them become hypokalemic this is just goes through on this graphic here um you're seeing like time of onset what's actually happening we have lack of insulin um and then you see the patient here with all the symptomology so typically they'll have some people can smell it some people can't but the patient will have like a fruity breath type smell um to their breath kuzmal's respirations very thirsty and dehydrated their sugar is generally greater than 240 and then the patient is uh hyperkalemic oh i just realized i think i said hypokalemia early so earlier it's high per kalemia so their uh blood uh potassium levels are actually elevated however you want to wash those potassium levels very closely because once we are giving insulin insulin also causes the shift of potassium to go back into the cell so then they can become hypokalemic so just to clarify because i think i said that backwards earlier so you might see hyperkalemia with a patient who is in dka but again regulate and watch those potassium levels when we're giving insulin because then they then they can become hypokalemic with that shift of potassium into the cell all right so going back to the outline so hyperglycemia this would be a patient who if they're hyperglycemic what we're seeing is that the finger stick blood sugar or their blood glucose level is going to be greater than 100 and normal range normally that we teach you guys is 70 to 100. so symptomology wise you might see that patient complain of blurred vision drowsiness don't forget the three p's that we just went over so in conjunction with the three ps they might have that blurred vision and drowsiness tingling pain or numbness to their hands and feet and slow or improper healing of cuts and bruises hypoglycemia um hypoglycemia typically can be more dangerous than hyperglycemia so this would be if the finger stick blood sugar or glucose level is less than 70. so symptomology they might be shaky weak i'm going to flip to the slide so you can see hypoglycemia as we're talking about this so here's the hyperglycemia slide um i didn't bring that up but we already went through all the symptomology and then here's our hypoglycemia patient okay so hypoglycemia um again could be shakiness weakness fatigue hunger sweating nerve nervousness they can even become confused lethargic they can even go into coma what i really want you to remember out of all the symptomology that you see there are the early signs okay the early signs would be the shakiness fatigue and confusion those are typically the earlier signs of hypoglycemia that you will see important to remember that symptoms and kiddos let's go back here symptoms in kids um typically you might see they're just more irritable or they could even be lethargic so important to remember that hypoglycemia requires immediate treatment immediate okay typically what we give nowadays what is more recommended is the cranberry juice followed by complex carbohydrates and protein so some type of complex carbohydrate like a turkey sandwich something like that so right now like american diabetic association is recommending the cranberry juice the reason why is you think about so remember earlier we talked about patients who are um when we're having issues with glucose control they can become hyperkalemic right so it used to be okay let's give the patient orange juice right to get that blood sugar back up if they're hypoglycemic but when we're concerned about which way their potassium level is going orange juice wouldn't be a great choice to have right because we know orange juice is high in potassium so we could in fact mess with their potassium levels and then you think about the patient who has renal failure maybe renal failure patients can excrete potassium very well right so if they're on dialysis they're not excreting it at all we need we have to do it via dialysis so if we give them orange juice we're just elevating those potassium levels even more so it's cranberry juice followed by that complex carbohydrate and protein we can give them cake mate you see cake made in the stores it's like that frosting right that you can put under the tongue so we want to really be careful that we're not over treating because it can take at least 20 minutes for the patient to feel the effects and for us to even really see a change in their glucose levels if we were to do um an accu check on their finger okay so a couple things that you must remember and is very important to remember if you're giving a patient a substance by mouth they have to be conscious and they have to be alert and oriented we don't put anything in anybody's mouth if they're not conscious okay must be conscious must be alert and oriented to give any po substance to elevate the blood sugar okay important to remember it's very appropriate to seek provider assistance and request iv glucose or dextrose for unconscious hypoglycemic patient right because we can't put anything in their mouth so it'd be very appropriate to seek the help from your provider and request that iv glucose or dextrose for that type of patient