Lesson 45: Diabetes Related Complications

 

In order to critically think for the NCLEX you need to have a basic understanding of these common diabetes related complications.

Hypoglycemia (Low Blood Sugar)
Blood glucose is less than 65
Signs:physical- trembling, tachy, shaking, hungry,weak, sweating
mental- incoherent, combative, belligerent, slurred speech
Cause: too much insulin
too much exercise
too little food
Treatment: Give a fast acting sugar (candy, glucose tablet, 8 ounze skim milk)
If client is unconscious give 50% Dextrose IV or Glucagon IM

Hyperglycemia (High Blood Sugar)
Blood glucose is 200-800
Signs: physical-3 P's, dehydration, weakness, tachy
mental-confusion, incoherent, stupor, lethargic
Cause: dehydration
illness
stress
missed dose of insulin

Other complications

Diabetic retinopathy is the result of changes of in the small vessels in the eyes due to poorly controlled blood sugar. Cataracts and blindness are common in diabetics, teach clients to get yearly eye exams.
Atherosclerosis is the result of blood vessels becoming hard due to uncontrolled diabetes, proper diet and exercise should be emphasized during treatment.
Infections are common in people with diabetes (foot, urinary tract, and yeast)
Lipodystrophy is the result of fatty masses that are produced when insulin injections are giving in the same place repeatedly. Teach clients the importance of injection site rotation.
DKA (please see link)
HHNS (please see link)

Dawn Phenomenon occurs between 5-8 am. The client will wake up hyperglycemic. Think "I am hyper at dawn" Give bedtime insulin to prevent this from happening.

Somogyi phenomenon is rebound hyperglycemia. It starts around 2am; at first the client will be hypoglycemic so the body releases stored insulin but the effect is hyperglycemia by 7am. Teach the client to eat a snack at bedtime to prevent this from happening.

The ABC's of Diabetes Care

A1c less than 7%
Blood pressure control
Cholesterol control
Diabetes education
Eye exam
Foot exam
Glucose monitoring