Unit 2: Diabetes Mellitus Nursing Management Part 2
Acute Complications of Diabetes Mellitus
- Two main classifications:
- Hypoglycemia: Blood sugar < 70 mg/dl.
- Hyperglycemia: Associated with conditions like Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS).
Hypoglycemia
Definitions
- Mild: Nervousness, irritability, hunger.
- Moderate: Confusion, poor coordination, headache.
- Severe: Disorientation, seizures, coma (< 40 mg/dl).
Causes
- Excess insulin or oral hypoglycemic agents (e.g., sulfonylureas).
- Excess physical activity.
- Insufficient food intake, especially before delayed meals or omitted snacks.
Symptoms
- Adrenergic (Sympathetic Nervous System)
- Sweating, tremors, tachycardia, nervousness, hunger.
- Central Nervous System (CNS)
- Inability to concentrate, headache, confusion, slurred speech, drowsiness.
Management
- Conscious patients: 15 grams of fast-acting carbohydrates (e.g., glucose tabs, juice).
- Recheck: Blood glucose after 15 minutes.
- Unconscious or Non-Swallowing Patients:
- Intramuscular glucagon.
- IV dextrose if glucagon is ineffective after 20 minutes.
Prevention
- Routine self-monitoring of blood glucose.
- Educate on recognizing symptoms.
- Carry a simple sugar source.
- Consistent eating and insulin administration patterns.
- Wear medical identification (bracelet, tag, or tattoo).
Hyperglycemia
Conditions
- Diabetic Ketoacidosis (DKA): Typically in Type 1 diabetes, involves ketone production and acidosis.
- Hyperglycemic Hyperosmolar Syndrome (HHS): Typically in Type 2 diabetes, no ketones or acidosis.
Management Considerations
- In acute care, ensure timely insulin administration, especially in relation to meal times to avoid hypoglycemic events.
Miscellaneous
- Importance of patient education on individualized symptoms and presentations of hypoglycemia and hyperglycemia.
- Considerations for patients on beta-adrenergic blockers (e.g., metoprolol) as they may not exhibit typical hypoglycemic symptoms.
These notes cover the key points from the lecture on diabetes mellitus nursing management, focusing on the acute complications of hypoglycemia and hyperglycemia, their symptoms, causes, management, and preventive measures.