PATHOPHYSIOLOGY BASICS

INsulin = puts INto the cell (sugar & K+) DIABETES MELLITUS TREATMENT—PATIENT EDUCATION
D–DIET –Low carbs
GLycogen = Stored GLucose in Liver TYPE 1 vs. TYPE 2 AVOID: Simple Sugars (soda, candy, white bread/rice, juices)
• Good High Fiber = BROWN (bean, rice, bead, peanut butter)
“whole wheat/grain/milk”
PATHO & CAUSES DIAGNOSTIC LABS • Bad Low fiber = White (bread, rice, bread potatoes (fries), low fat milk)
Type ONE Type TWO D–DIABETIC FEET “Delicious Feast for bacteria”
HgBA1C
GOAL: Clean, Dry, Injury Free
DON't-produce insulin (Born) FEW-insulin receptors work AVOID
Autoimmune “body attacks itself” “Insulin resistance” (Diet) F–Flip Flops, high heels, Nylon,
SON-hereditary YOU-diet “high simple sugars” O–OTC corn removal
& sedentary lifestyle O–Overly HOT (baths, pads etc.)
T–Toe Injuries — cut nails STRAIGHT
NCLEX KEY WORDS:
Daily inspection — NOT weekly
Shoes fit properly — NO sandals
SIGNS & SYMPTOMS SOFT Cotton Socks — NOT nylon
Nails trimmed–cut straight — NOT curved angles
HIGH sugar LOW sugar (70 or LESS) Non healing skin wounds — Report to HCP (Dr.)
hot and dry = sugar high cold and clammy need some candy NO callous removal
“Hyperglycemia” Hypoglycemia NO heavy Powder — light powder
(blood turns to mud) MORE SEVERE! “Hypogly Brain will Die!” NO rubbing feet hard “vigorously”
3 P’s: Polyuria • Cool, pale “pallor”, sweaty, NO HOT baths or HOT pads — warm is ok
Polydipsia clammy = candy NOT hot or flushing
Polyphagia • Trembling, Nervous, Anxious
• HIWASH = Headache, Irritable, Weakness, COMPLICATONS
Anxious, Sweaty, Shaky, Hungry KIDNEY–Nephropathy (High Creatinine OVER 1.3)
RISK FACTORS CAUSES EYE–Retinopathy (blind)
HEART–HTN & Atherosclerosis
Type ONE -None (born) HIGH sugar (115 or MORE) LOW sugar (70 or LESS) BRAIN–CVA (strokes)
Type TWO Sepsis (infection #1 cause), Exercise NERVES–Neuropathy (loss of feeling)
Stress (surgery, hospital stay), Alcohol
“MetaBOLic Syndrome”-Increased risk for diabetes, heart disease, stroke
Skip insulin Insulin PEAK times
B–BP meds or HTN (over 130 sysolic) NOTES
Steroids (predniSONE) MOST DEADLY! “Hypogly brain will DIE”
B–Blood Sugar Meds (insulin, oral diabetics) or High Blood Sugar (over 100+)
TREATMENT: Insulin 1st TREATMENT:
O–Obese (waist size: 35+ Female 45+ Male)
L–Lipids HIGH Total Cholestrol/Triglyceride/LDL 200-150-100—HDL 40 Awake? Ask to eat:
(higher LDL and lower HDL are risk factors) Juice, Soda, Crackers, Low Fat Milk
NOT high fat milk or peanut butter
*3 or MORE criteria*
Sleep? Stab them (D50 given IV/IO)
 INSULIN TYPES ORAL HYPOGLYCEMICS (Type 2 Only) 7 INSULIN TIPS
1. DIET & EXERCISE BEFORE oral meds and insulin 1. Peaks + Plates = Food during PEAK times (prevent HYPOgly=brain die)
2. METFORMIN–Minimal chance of Low Sugar “hypoglycemia” 2. NO Peak NO Mix = Long acting “old guys”–Detemir & Glargine
1. Weight GAIN 3. IVP or IVPB ONLY = Regular insulin “ready to go IV”
2. Lactic Acidosis: NO Alcohol + STOP 48 hours before and 4. Draw Up: Clear to Cloudy “you want CLEAR days before cloudy ones”
after cath 5. Rotate locations-Macarena-BEST on abdomen
IV Contrast = Kills Kidney
(2 inches from: Umbilicus, Naval, “belly button”)
3. GLIPIZIDE GLYBURIDE–Heart can DIE (bad for CHF)
6. DKA - Type 1–“sick days”–YES INSULIN without food!!!
LOW blood sugar (Avoid alcohol “ETOH” = hypoglycemia)
TOXIC: Renal, Liver & elderly population 7. Hypoglycemia (70 or LESS)
Sun Burns = sunscreen & protective clothing Awake = Ask them to Eat (soda, juice, low fat milk)
4. THIAZOLIDINEDONE (TZD) Pioglitazone (ONE heart) Sleeping = Stab with IV D50 (dextrose 50)
NO Heart Failure patients–new pitting edema, crackles (lungs) "Unresponsive" "Responsive ONLY to pain"
NO Liver failure patients “Cirrhosis” “Liver Failure”

NOTES

NPH

PEAK TIMES=Hypoglycemia risk 70 or Less

Hypogly brain will DIE NCLEX TIP
 DKA HHNS
PATHO & CAUSES: PATHO & CAUSES:
TYPE 1–Faster & Younger “D comes 1st in alphabet” TYPE 2–slower & older “H comes 2nd in alphabet”
S–Sepsis (infection) NCLEX TIP Illness
FRUITY BREATH
S–Sickness "Stomach Virus & Flu" (most commom) Infections
S–Stress (surgery) Older age Harder to fix
S–Skip insulin Easier fix
SIGNS & SYMPTOMS:
SIGNS & SYMPTOMS:
D–Dry & High sugar 250—500+ H–HIGHEST SUGAR OVER—600+
K–Ketones & Kussmaul resp. (Deep/rapid/REGULAR H–HIGHER fluid loss & Extreme dehydration NCLEX TIP
respirations and fruity breath) H–Head change–LOC, Confusion, Neurological Manifestations NO FRUITY BREATH

A–Abdominal Pain N–No keytones No Acid, (NO fruity breath/ketones)

A–Acidosis Metabolic LESS than 7.35 (normal 7.35—7.45) S–Slower Onset & Stable Potassium (3.5-5.0)
Hyperkalemia (Abnormally high K+) TREATMENT:
TREATMENT: H–Hydration–0.9% NS 1st, then HYPOtonic NCLEX TIP
D–Dehydration FIRST! (0.9% normal saline) S–Stabilize Sugars (Insulin)
K–Kill the sugar (SLOWLY) prevent low sugar CAUTION: Insulin IV = ONLY Regular Insulin
*Hourly BS checks* “land the plane slow & smooth” • IV bolus
Over 250: IV Regular insulin ONLY (bolus 1st) • IV titration
Below 200 (or ketones resolve): SQ insulin + 1/2 NS • SQ injection & IV
with D5W IV • SQ only
A–Add Potassium K+ (Yes even if norm: 3.5 - 5.0)
During IV Insulin
IN-sulin = sugar & K+ IN the cell DKA patients DIE from hypokalemia where
HHNS patients die from hypovolemia

RE-ASSESSMENT Potassium IV (Normal 3.5 - 5.0) POTASSIUM PUMPS MUSCLES NOTES

Blood Glucose Hourly • First Action = Heart monitor High Potassium (5.0+) Low Potassium (Below 3.5)
COMMON NCLEX QUESTION Re-Hydration Signs: Never push = DEATH High Pump Low Pump
Q: Child is nauseous NOT • BP stable & Cap Refill (3 sec or less) • 10–20 mg MAX per hour IV!! (IV Pump) Peaked T waves, ST elevation Flat T wave, ST depression, U wave
eating—maybe vomiting—do • Skin color & warm temp (NOT cool/pale) • Site (central) and Slow infusion
you still give INSULIN? • 30ml/hr + Urine Output
• Low spec gravity (1.005–1.030)
A: Yes, we give sick day insulin to NOT Apical pulse NOT Lung sounds NOT Pupils
prevent DKA...because glucose
is HIGH during times of illness.