Chapter 20

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Chapter 20
2014-03-07 14:35:08

Acute Diabetic Emergencies
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  1. Diabetes Mellitus (DM)
    A disease that frequently causes changes in the patient's mental status resulting from alterations in the blood glucose level
  2. Glucose
    • A major source of fuel for the cells.
    • Maintenance of the glucose level in the blood is crucial to normal function of cells
  3. Insulin
    • Secreted when the blood glucose level is elevated.
    • Three main functions:

    • 1. It increases the movement of glucose out of the blood and into the cells
    • 2. It causes the liver to take up the glucose out of the blood and convert it into glycogen, the stored form of glucose
    • 3. It decreases the blood glucose level by the actions listed in 1 and 2: facilitating the movement of the glucose into the cells and the liver
  4. Glucagon
    • Secreted when the blood glucose level is low and will work to increase the blood glucose level.
    • Major functions of glucagon:

    • 1. It converts glycogen stored in the liver back into glucose and releases it into the blood
    • 2. It converts other, noncarbohydrate substances into glucose in the liver
    • 3. It increases and maintains the blood glucose level by the actions listed in 1 and 2: converting glycogen and other substances into glucose
  5. Normal Blood Glucose Level
    70-120 mg/dL
  6. Hypoglycemia
    • Typically defined as a BGL of 60 mg/dL or less with signs and symptoms of hypoglycemia or a BGL of less than 50 mg/dL with or without symptoms of hypoglycemia
    • The primary sign of hypoglycemia is an altered mental status
  7. Hyperglycemia
    A persistent BGL greater than 120 mg/dL
  8. Type 1 Diabetes
    • Referred to as insulin-dependent diabetes mellitus (IDDM) since these patients are required to inject insulin to regulate their blood glucose levels. Type 1 patient's pancreas usually doesn't secrete any insulin
    • Typically younger when the diabetes occur, under age 40. Peak age 10-14
  9. Diabetic Ketoacidosis
    A condition typically found in type 1 diabetics where the blood glucose level is excessively elevated and insulin level is extremely low to absent, which causes glucose to be excreted in the urine, dehydrating the patient, and causes the body to metabolize fat for energy, producing ketones and creating an acidic environment
  10. Type 2 Diabetes
    • Referred to as non-insulin-dependent diabetes mellitus (NIDDM) because type 2 diabetics usually do not have to take insulin
    • Have to regulate diet and exercise and take oral drugs to help the pancreas secrete more insulin or to make the insulin that is secreted more effective in facilitating movement of glucose into the cells.
    • Usually middle age or older typically overweight
  11. Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
    A condition typically found in type 2 diabetics where the blood glucose level rises excessively, causing loss of large amounts of fluid from glucose spilling into the urine, leading to severe dehydration
  12. The Three Ps
    Because the higher than normal loss of body fluid, diabetes mellitus patients typically complain of frequent thirst (polydipsia) and urination (polyuria). Also because the cells are starving for energy, the patient is typically hungry (polyphagia)
  13. Oral Glucose
    Medication of choice in the emergency care of the diabetic patient with an altered mental status
  14. Diabetic Ketoacidosis (DKA)
    • The¬†blood glucose level is elevated, usually greater than 350 mg/dL, because of an inadequate amount of insulin
    • The brain has excess amount of glucose, therefore is not suffering from low blood glucose
    • Other cells in the body are starving for glucose, because there is an inadequate amount of insulin to help move the glucose out of the blood and into the cells at a fast enough rate