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4570620
Type 1 Diabetes
Description
General overview
No tags specified
acute care nursing theory i
diabetic care
307
Mind Map by
natalieszabat
, updated more than 1 year ago
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Created by
natalieszabat
over 8 years ago
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Resource summary
Type 1 Diabetes
Characterized by the destruction of pancreatic beta cells
Genetic
Human leukocyte antigen (HLA) types
HLA DR3
HLA DR4
Environmental
Viruses
Toxins
Immunological
Antibodies against islet cells & endogenous insulin
Clinical manifestations
Polyuria
Polydipsia
Polyphagia
Assessment & diagnostic findings
Fasting plasma glucose level (FPG)
7.0 mmol/L or more
A1C lab test
Normal A1C level is below 5.7 percent
5 components of diabetes management
Nutrition
Exercise
Education
2 main types
"Survival skills"
In-depth, advanced continuing education
Monitoring
SMBG 4x daily
Before meals
At bedtime
Urine testing for ketones
If glucosuria present
During illness
In pregnancy
Persistently elevated glucose levels
Pharmacologic therapy
Insulin therapy
Conventional regimen
Terminally ill
Frail older adult w/ limited self-care capabilities
Patients unwilling to engage in self-management activities
Intensive regimen
Allows for more control over blood glucose levels
Ineligible candidates
Nervous system disorders rendering them unaware of hypoglycemia episodes
Reoccurring severe hypoglycemia
Irreversible diabetic complications
Blindness
ESRD
Cerebrovascular and/or cardiovascular disease
Ineffective self-care skills
Patient characteristics
Onset any age, but usually young (younger than 30)
Usually thin at diagnosis
Complications
Acute
Hypoglycemia (insulin reactions)
Causes
Too much insulin
Too many hypoglycemic agents
Too little food
Excessive physical activity
Description
Blood glucose falls to <2.7-3.3 mmol/L
Clinical manifestations
Mild hypoglycemia
Sweating
Tremor
Tachycardia
Palpitation
Nervousness
Hunger
Moderate hypoglycemia
Headache
Inability to concentrate
Light-headedness
Confusion
Memory lapses
Slurred speech
Numbness of lips & tongue
Combative behaviour
Impaired coordination
Emotional changes
Double vision
Drowsiness
Severe hypoglycemia
Disoriented behaviour
Seizures
Loss of consciousness
Difficulty arousing from sleep
Treatment/interventions
15g of fast-acting concentrated source of carbohydrate
If unconscious/cannot swallow
1mg glucagon administered subcutaneously
Diabetic ketoacidosis
Cause
Absence or markedly inadequate amount of insulin
Decreased or missed dose
Illness or infection
Undiagnosed/untreated diabetes
Main clinical features
Hyperglycemia
Dehydration & electrolyte loss
Acidosis
Signs & symptoms
Polyuria
Polydipsia
Blurred vision
Weakness
Headache
Orthostatic hypotension
Weak, thready pulse
GI symptoms
Anorexia
Nausea
Abdominal pain
Vomiting
Kussmaul respirations
Low pCO2 level
10-30 mm Hg
Lethargy
Diagnostic findings
Low serum bicarbonate
0-15 mmol/L
Low pH
6.8-7.3
Prevention
Teach "sick day" rules
Medical management
Fluid resuscitation
Avoidance of hypokalemia
Insulin administration
Avoidance of rapidly falling serum osmolality
Search for cause
Hyperglycemic hyperosmolar nonketotic syndrome
Not common in type I diabetes
Chronic
Microvascular disease
Coronary artery disease
Peripheral vascular disease
Cerebrovascular disease
Microvascular disease
Retina
Kidneys
Neuropathy
Peripheral (sensorimotor) nerves
Autonomic nerves
Spinal nerves
Retinopathy
Nephropathy
Foot & leg problems
Neuropathy
Peripheral vascular disease
Immunocompromise
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