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cris_tal1303
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Somogyi Effect
Mourning hyperglycemia from a counter-regulatory response to night time hypoglycemia
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Treat somogyi effect
- less insulin
- check blood sugar b/n 2 & 4am
- if b.s is low reduce am insulin
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Dawn Phenomenon
hyperglycemia from a nighttime release of growth hormone that causes b.s elevations at about 5am to 6am
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Treat Dawn Phenomenon
- change in timing of dose (later)
- more insulin & bedtime snack
- check b.s b/n 2 & 4am
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DKA-Diabetic Ketoacidosis
- TYPE I Problem
- Profound defiency of insulin
- BS>300
- Dehydration
- Fruity breath
- Kussmaul Respirations
- anorexia
- n/v (metabolic acidosis)
- weakness, lethargic
- electrolyte imbalance
- lead to coma
- death
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Management Ketoacidosis
- Continuous IV infusion of insulin
- I/V hydration w/ NSS initially
- electrolyte replacement
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HHS- Hyperglycemic Hyperosmolar State
- TYPE II Problem
- produce enough insulin to prevent DKA
- not enough insulin to prevent hyperglycemia, osmotic diuresis or ECF depletion
- Inc in serum osmolarity
- BS>400
- ketones are absent
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Treatment of DKA & HHS
- medical emergency
- IV NSS or 1/2 NSS
- IV Reg Insulin
- BS below 250 add IV Glucose (D5 1/2)
- Electrolyte Replacement
- Cardiac Monitoring (high K)
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Lipoatrophy
loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in insulin
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Treat Lipoatrophy
injection of insulin at the edge of the atrophied area
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Lipohypertrophy
increased swelling of fat that occurs at the site of repeated insulin injection
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Treat lipohypertrophy
rotating injection injection site among different body areas
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