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Why do patients get hypoglycemic
because the patient didn't eat or they got too much insulin
occurs in the morning hours during sleep we have circadian rhythm that starts to waken us. During this period there is more production of growth hormone ( around 5-6 am) We also have cortisol being produced in a higher amount and this leads to higher level of blood glucose.
so this hyperglycemia occurs because of cortisol and growth hormone
book says normal BG until about 3AM
How do you treat the dawn phenomenon
You would treat with insulin when you find the patient hyperglycemia at that point in time
change time of injection of evening intermediate acting insulin from dinner time to bed time.
so the insulin we gave lowered the BG and our body tries to keep us alive somewhere in the middle of the night and raises it
- Nurses find this more often that physicians
- the patient gets a dose of insulin in the evening or hour of sleep.
- They have a "dip" in blood glucose some where between 2:30 am to 4:00am because of the insulin we gave them.
- the body is smart and uses counter regulatory methods ( glucagon and gluconeogensis) and we end up having higher glucose because the body is trying to "save our life"
how do you treat somogyi effect
Give short acting insulin when you find patient in the morning
decrease evening ( predinner or bedtime) dose of intermediate acting insulin or increase bedtime snack
what does the dawn and somogyi effect have in common
In both of these the patient has high blood glucose in the morning
American diabetic diet
1600 calories and then the recommended values in carbs fat protein
illness & stressors..
what should the nurse do
what should the patients do?
- People who have stressors need more food
- e.g. pregnancy.. predicates turns into gestational diabetes
- need more insulin and more cho
- our body elevates bgm when we are stressed
if you're a diabetic and you take insulin you have to continue to take it when you're stressed
- more cho is needed
- and more insulin
- if you stop taking them, the body can't function
sick day rules
- let the pt have what they want
- emergency kit of foods you will eat
- blood sugar will elevate when sick because of gluconeogenisis
- Simple sugars are better and easier to digest but it is entirely up to the patient
- keep well hydrated.
more insulin is needed so patient has to at least take their regular dose
monitor the glucose more than usual. E.g. if you used to check it 4 times a day, you should probably do it q 3-4 hours depending on how high it goes
Urine ketone test: turns purple/lavender if positivewhen you're sick you need calories you can drink
- whatever you want doesn't have to be diet coke, can be regular
extreme way to check dehydration is by weighing the patient
if they lose 1L of fluid that is 1kg loss
Ketone monitoring is usually for type 1 diabetes
exercising means they are using more calories and need more carbs so they shouldn't exercise
1. Patient should be keeping vial of insulin at home
2. Patient should eat easily digested food when sick but if they don't want to let them have whatever
3. frequent small amounts of food
- 1. exta regular insulin should be at home: SSI uses regular insulin because it is fast acting. The vial should be kept in the fridge but if its open it should stay outside for 30 days. Do not keep insulin in hot places
- 2. simple sugars are easily digested
- 3.if someone doesn't feel well don't present with full meal -> no nausea
- 4. calll doctor if vomiting a lot and nothing is going down
- Temp & syncope means they are getting dehydrated
- change in loc can mean they are getting ketotic
- can be prevented if bgm is kept in the normal rage 60-100
- hemoglobin between 4-6.7
what are some chronic complicaations?
- venus insufficiency you would elevate feet
- arterial you do not
peripheral micro vascular insufficiences & peripheral neuropathies
Pain/ burning on their feet or limbs
wet to dry dressing only used if someone has necrotic tissue
loss of sensation ..
- makes patient at risk to infections and bruises.
- patient should examine foot every night
microvascular insuffiences and peripheral neuropathy problems cause other problems too
- bowel and bladder incontinence
- impotence more common in men
- gastroporesis: decrease in peristalsis and gastric emptying
high sugar levels
Ambulation issues are due to neuropathy
Decrease in renal function: