Diabetes Assessment
- Juvenile Onset
 - Absent Insulin Production
 - Ketosis Prone
 - Adult Onset
 - Insulin Resistance
 - Obesity
 - Onset During Pregnancy
 - Glucose Intolerance
 - Retinopathy
 - Peripheral Vascular Disease
 - Nephropathy
 - Neuropathy
 
Oral Glucose Tolerance Test (OGTT)
- Used for Diabetes Screening
 - Fasting State
 - Baseline
 - Normal < 100 mg/dL
 - 30 and 60 Minutes
 - Normal < 200 mg/dL
 - 120 Minutes
 - Normal < 140 mg/dL
 
Diabetic Ketoacidosis (DKA) Signs and Symptoms
- Kussmaul respirations
 - Dehydration
 - Abdominal Pain
 - Nausea/vomiting
 - Psychosis
 - Fruity breath Odor
 
Diabetic Ketoacidosis (DKA) Diagnosis and Labs
- Blood glucose Increased > 250 mg/dL
 - Anion gap metabolic acidosis
 - Decreased pH < 7.3
 - Decreased serum bicarbonate < 18
 - Plasma ketones
 - Hyperkalemia
 
Diabetic Ketoacidosis (DKA) Treatment
- IV Normal Saline
 - Regular Insulin Drip
 - Potassium (K+)
 - Glucose
 - Treat Underlying Cause
 - Venous pH
 - Serum Bicarbonate (HCO3)
 
Diabetic Glomerulonephropathy
- Nonenzymatic Glycosylation of Glomerular Basement Membrane
 - Nonenzymatic Glycosylation of Arterioles
 - Hyperfiltration
 - Increased GFR
 - Hyaline Arteriolosclerosis
 - Mesangial Expansion
 - Type IV Collagen Deposition
 - Kimmelstiel Wilson Lesions
 - Nephrotic
 
Dawn Phenomenon
- Increased Hormone Production
 - Hyperglycemia Upon Awakening
 - Long-Acting Evening Insulin
 - Change Administration Times
 - Insulin Pump
 - Closely Monitor Glucose Levels
 - Between 2-6AM
 - Limit Carbohydrates Before Bedtime
 
Corrected Na+ for Hyperglycemia
- [(Glucose-100) * 0.016 ] + Na+
 - Glucose-100
 - Multiply * 0.016
 - Add Na+
 
Diabetes Education
- Self-Monitoring (Blood Glucose)
 - SubQ Injection Technique
 - Lifestyle Changes
 - Symptoms of Hyperglycemia and Hypoglycemia
 - Sick Day Care
 - Foot Care
 - Exercise Therapy
 - Medication
 
Metabolic Syndrome
- Dyslipidemia
 - Central Obesity
 - Insulin Resistance
 - Hypertension
 - Increased C-Reactive Protein (CRP)
 - Increased Fibrinogen
 - Increased Risk Cardiovascular Disease
 
Gestational Diabetes
- Usually Asymptomatic
 - Fetal Macrosomia
 - Polyhydramnios
 - Glucose Intolerance After 24 Weeks Gestation
 - 3-hr 100g Glucose Tolerance Test
 - Diet and Exercise
 - Close Glucose Monitoring
 - Insulin
 - Ultrasound (or Nonstress Test (NST))
 - Delivery
 
Acanthosis Nigricans
- Endocrine Disorders
 - Diabetes Mellitus
 - Obesity
 - Malignancy
 - Velvety Plaques
 - Dark, Thickened Flexural Areas
 - Hyperkeratosis with Melanocytes
 - Treat Underlying Disorder
 
Hyperosmolar Hyperglycemic State
- Insulin Present
 - Increased Serum Osmolality
 - Glucose >600 mg/dL
 - No Significant Acidosis or Ketosis
 - Severe Dehydration
 - Altered Neurological Status
 - Tachycardia and Hypotension
 - IV Fluids
 - Insulin
 - Treat Underlying Disorder
 
Nonproliferative Diabetic Retinopathy
- Increased Capillary Permeability and Leakage
 - Often Asymptomatic
 - Retinal Microaneurysms
 - Flame-shaped Hemorrhages
 - Cotton Wool Spots
 - Hard Exudates
 - Macular Edema
 - Treat Diabetes
 - Laser Photocoagulation
 - Bevacizumab 
 
Pregnant Diabetic Patient Interventions
- Increase Insulin then Decrease
 - Metformin
 - Nutrition
 - Exercise
 - Increase Insulin
 - More Likely to Develop Hypoglycemia than Hyperglycemia
 - Double or Quadruple Insulin
 - Early Delivery
 - Drastically Decrease Insulin
 - Monitor Neonate for Hypoglycemia
 
Diabetes Interventions
- Early Diagnosis
 - Insulin
 - Oral Hypoglycemics
 - Glucose Monitoring
 - Routine Exercise
 - Diabetic Diet
 - Monitor for Complications
 - Insulin Therapy
 - Diabetic Ketoacidosis (DKA)
 
Proliferative Diabetic Retinopathy
- Angiogenesis
 - Increased VEGF
 - Asymptomatic Until Late-stage
 - Vitreous Hemorrhage
 - Retinal Detachment
 - Glaucoma
 - Findings of Nonproliferative Diabetic Retinopathy
 - Laser Photocoagulation
 - Surgery
 - Bevacizumab