Diabetes & Hypoglycemia Study Guide

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Diabetes Mellitus (DM)

Definition

Diabetes Mellitus is a group of diseases involving impaired glucose metabolism due to problems with insulin production or insulin use.

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Important Concepts

Insulin regulates:

• Carbohydrates
• Proteins
• Fats

In diabetes:

• Glucose builds up in blood and urine
• Cells cannot properly use glucose for energy
• Beta cells in the pancreas produce insulin
• Long-term vascular damage occurs over time

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Types of Insulin

• Endogenous insulin = made by the body
• Exogenous insulin = injected insulin

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Types of Diabetes

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Type 1 Diabetes Mellitus

Characteristics

• Insulin-dependent (IDDM)
• Usually develops before age 30
• Autoimmune destruction of beta cells
• Requires lifelong insulin

Major Complication

• Diabetic Ketoacidosis (DKA)

Signs & Symptoms

• Polyuria
• Polydipsia
• Polyphagia
• Rapid weight loss
• Weakness/fatigue
• Nausea/vomiting

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Type 2 Diabetes Mellitus

Characteristics

• Non-insulin dependent (NIDDM)
• Usually develops after age 30
• Insulin resistance
• Increasing in children/adolescents

Risk Factors

• Obesity
• Older age
• Family history
• Physical inactivity
• Hypertension
• Metabolic syndrome
• Gestational diabetes history

Signs & Symptoms

• Weight gain
• Fatigue
• Blurred vision
• Poor wound healing
• Tingling/numbness in feet
• Polyuria, polydipsia, polyphagia

Major Complication

• HHS / HHNS

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Gestational Diabetes

Key Points

• Occurs during pregnancy
• May require diet, oral meds, or insulin
• Increases future risk of Type 2 diabetes

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Diagnosis of Diabetes

Hemoglobin A1C

Level	Meaning
< 5.7%	Normal
5.7–6.4%	Prediabetes
≥ 6.5%	Diabetes

• Reflects ~3-month average glucose

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Fasting Blood Glucose

• 70–100 mg/dL (normal)

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Diabetic Ketoacidosis (DKA)

Cause

Lack of insulin → fat breakdown → ketones

Common Causes

• Infection
• Missed insulin
• Pump failure

Signs & Symptoms

• Ketonuria
• Fruity breath
• Kussmaul respirations
• Polyuria
• Polydipsia
• Nausea/vomiting
• Dehydration

Potassium Changes

• Initial: Hyperkalemia
• Treatment phase: Hypokalemia

Treatment

• IV fluids (NS/LR)
• IV insulin drip
• Cardiac monitoring
• Monitor glucose + potassium

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Hyperosmolar Hyperglycemic State (HHS)

Key Features

• Type 2 diabetes
• Glucose > 600 mg/dL
• Severe dehydration
• No ketones
• No acidosis

Causes

• Infection
• Illness
• Stress
• Steroids
• CHF
• Renal disease

Treatment

• Aggressive IV fluids
• Electrolytes
• Cardiac monitoring
• Treat underlying cause

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Hypoglycemia

Definition

Blood glucose < 70 mg/dL

Causes

• Too much insulin
• Skipped meals
• Exercise
• Alcohol
• Insulin overdose

Signs & Symptoms

• Tremors
• Tachycardia
• Sweating
• Weakness
• Confusion
• Cool, clammy skin
• Headache

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Treatment (15/15 Rule)

1. Give 15 g fast carbs
2. Wait 15 minutes
3. Recheck glucose
4. Repeat if needed

Fast Carbs

• Juice (4 oz)
• Glucose tabs
• Regular soda
• Hard candy
• Sugar/honey

Follow-up snack

• Peanut butter
• Cheese
• Milk

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Severe Hypoglycemia

If unconscious:

• IM glucagon
• IV D50
• Side-lying position

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Hyperglycemia

Causes

• Missed insulin
• Infection
• Stress
• High carbs

Signs & Symptoms

• Polyuria
• Polydipsia
• Polyphagia
• Dry mouth
• Weakness
• Fruity breath
• Kussmaul respirations

Treatment

• IV fluids
• Electrolytes
• Insulin

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Dawn Phenomenon vs Somogyi Effect

Dawn Phenomenon

• Morning hyperglycemia from hormones

Treatment: increase nighttime insulin

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Somogyi Effect

• Night hypoglycemia → rebound hyperglycemia

Symptoms:

• Nightmares
• Night sweats
• High morning glucose

Treatment:

• Reduce nighttime insulin
• Add bedtime snack

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Long-Term Complications

Cardiovascular

• CAD
• PAD
• MI
• PVD

Nephropathy

• Kidney damage
• Proteinuria
• Possible ESRD

Retinopathy

• Vision loss
• Retinal damage

Neuropathy

• Numbness/tingling
• Pain
• Sexual dysfunction
• Neurogenic bladder

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Diabetes Management

Goals

• Control glucose
• Maintain healthy weight
• Prevent complications

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Medications

Metformin

• First-line for Type 2
• Hold before contrast/surgery
• Restart after 48 hrs if kidneys stable

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Insulin Types

Type	Key Point
Rapid	With meals
Short	Meal required
Intermediate	Longer acting
Long	Basal insulin

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Injection Sites

• Abdomen (fastest)
• Upper arm
• Thigh
• Buttocks

Important:

• Rotate sites
• Do not massage injection site
• Prevent lipohypertrophy

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Insulin Pumps & CGM

Insulin Pump

• Continuous insulin delivery
• Mimics pancreas
• Change site every 3 days

CGM

• Continuous glucose monitoring
• Interstitial glucose readings

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Nutrition

Guidelines

• Small frequent meals
• Complex carbs

Include

• Fruits
• Vegetables
• Dairy

Limit

• Sugar
• Fat/cholesterol

Carb Ratio

• 1 unit insulin ≈ 15g carbs

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Exercise

Benefits

• Improves glucose use
• Improves circulation
• Weight loss
• Improves lipids

Recommendations

• 30 min/day
• Check glucose before exercise
• Carry snack

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Foot Care

• Inspect daily
• Dry between toes
• Proper footwear
• No open-toed shoes
• Never soak feet
• Report wounds early

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Sick Day Rules

• Continue meds unless instructed
• Check glucose q3–4 hrs
• Check ketones if glucose > 300
• Report vomiting/fever/pain

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Travel Tips

• Carry extra meds
• Wear medical ID
• Carry glucose snacks
• Teach companion emergency care

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Older Adult Considerations

• Hypoglycemia may be sudden
• Symptoms may be subtle
• Focus on regular meals
• Higher risk of malnutrition

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Nursing Priorities

DKA

• Fluids
• Insulin drip
• Potassium monitoring

HHS

• Dehydration management
• Cardiac monitoring

Hypoglycemia

• 15/15 rule
• Recheck glucose

Foot Care

• Prevent amputations

Education

• Med adherence
• Diet
• Exercise
• Monitoring