Alright. In this video, we are going to talk about
the complications of diabetes. So this includes hypoglycemia, DKA, HHS, as
well as some of the chronic complications of diabetes. So they're going to be some important critical
care topics here that you'll definitely need to know. Let's first talk about hypoglycemia. That is defined as a blood glucose level under
70 mg/dL. What are some causes of hypoglycemia in diabetes
patients? Well, if they have excess insulin, that can
definitely cause hypoglycemia. If they skip a meal or just decrease their
food intake, that can also cause hypoglycemia. Other causes include exercise, as well as
excess alcohol. The signs and symptoms of hypoglycemia are
important to remember. And those are all here on the back of card
46. So those include hunger, irritability, confusion,
diaphoresis, headache, shakiness, blurred vision, pale, cool skin, and decreased level
of consciousness that could progress into a coma. So regarding the skin, you remember when we
were talking about hyperglycemia, I was like, "If the skin is warm and dry, sugar's high." With hypoglycemia, if the skin is cold and
clammy you need some candy. So cold and clammy skin is definitely a sign
of hypoglycemia. In terms of nursing care of a patient with
hypoglycemia, if that patient is conscious and their blood sugar levels are under 70,
you can give them 15 grams of a readily absorbed carbohydrate. So this can be a half a cup of juice or soda
or like eight ounces of milk. Then you're going to want to recheck their
blood glucose in about 15 minutes. If their blood glucose level is still under
70, then you'll want to give them another dose of carbohydrates, so some more juice
or soda or milk. And then, again, recheck. Once their blood glucose level is over 70,
then you want to provide the patient with a snack that contains both a protein and a
carbohydrate. Alright. For your unconscious patient, you're going
to want to provide glucagon through the IM or subcutaneous route. So my little saying to remember glucagon is,
"When the glucose is gone, your patient needs glucagon." So if, after you give the glucagon, your patient
has not regained consciousness within 10 minutes, then you're going to give them another dose
of glucagon. Once your patient has regained consciousness
and can safely swallow, then you can provide them a snack at that point. I will warn you that glucagon does cause nausea
and vomiting so once your patient is conscious, you want to not only make sure they can safely
swallow, you're going to also want to make sure that they're not going to just vomit
up whatever snack you give them. So just something to keep an eye on. Alright, now let's talk about DKA, which is
diabetic ketoacidosis. This is a life-threatening complication of
diabetes that causes increased blood glucose levels as well as ketones in the blood and
urine. It is definitely more common with Type 1 diabetics,
and it has a rapid onset. So some of the risk factors associated with
DKA include an infection or illness, as well as stress and untreated or undiagnosed Type
1 diabetes. So often at the hospital, patients will show
up with DKA at the emergency room and that is the first time that they find out that
they have Type 1 diabetes. In terms of the signs and symptoms, because
the patient will have hyperglycemia, we're going to see the same signs and symptoms that
I talked about in my previous video associated with hyperglycemia. So this includes the three Ps-- so polydipsia,
polyphagia, polyurea, as well as weight loss, fruity breath odor, Kussmaul respirations,
and dehydration. Labs are going to be important to know how
to differentiate DKA from HHS. So with DKA , blood glucose will be elevated
over 300. And you will have ketones in the urine as
well as the blood. That is different than HHS. HHS will actually have higher levels of blood
glucose, often over 600. And there will be no ketones in the urine
or blood. Also with DKA, we're going to see metabolic
acidosis present in the patient, as well as hyperkalemia. And anytime we have an abnormality in potassium
levels, either too high or too low, the patient is at risk for life-threatening dysrhythmias. So when you see the word DKA, K is in the
middle and that will help you to recall that you need to closely monitor the patient's
potassium levels because they're going to be really high and that can definitely cause
some life-threatening dysrhythmias, like I said. Now moving on to HHS. HHS stands for hyperglycemic hyperosmolar
state. With HHS, we have very high glucose levels
as well as severe dehydration. HHS has a more gradual onset and it is definitely
more common with Type 2 diabetic patients. So if you look at the initials HHS, there
are two Hs, which will hopefully remind you that HHS is more common with Type 2 diabetes. Some of the causes and risk factors associated
with this condition include older age, inadequate fluid intake, decreased kidney function, as
well as infection and stress. Signs and symptoms of HHS will include the
signs and symptoms of hyperglycemia, which we've talked about a lot, in addition to the
signs and symptoms of dehydration, which may include hypotension, weak pulses, headache,
and weakness. In terms of the labs, blood glucose levels
will be over 600, and there will be no ketones in the urine or blood and no metabolic acidosis
present like we saw with DKA. Now, let's talk about the treatment of DKA
and HHS. First of all, we're going to want to identify
and treat any underlying cause of these complications. So if the patient has an infection, we're
going to want to treat that infection. We're going to be administering IV fluids
and insulin to the patient, and we're going to want to check their blood glucose levels
hourly. And our goal is to bring those levels under
200. If the patient has metabolic acidosis with
DKA, we're going to administer bicarbonate. We're also going to closely monitor the patient's
potassium levels. So when the patient first presents to the
emergency room with DKA, their potassium levels are going to be very high. And we're going to want to give them calcium
gluconate to help protect the heart from dysrhythmia. However, as we treat the patient with insulin,
insulin helps to bring glucose from the bloodstream into the cells. But it also brings potassium from the bloodstream
into the cells. So over the course of treatment, the patient
may end up with hypokalemia. And if that is the case, then we're going
to want to replace their potassium as needed. The last thing I want to touch on in this
video are some of the chronic complications of diabetes. There's a lot of them. And left untreated and not managed, diabetes
can really ravage the body and cause so many problems. So as a nurse, you need to really provide
education to your patient on these risks. So some of the complications associated with
diabetes include cardiovascular disease, which can lead to a myocardial infarction as well
as a stroke; diabetic neuropathy, which can lead to neuropathic pain as well as foot injury
and infection. It can cause nephropathy, so kidney damage,
as well as retinopathy. So damage to the eyes which can lead to blindness. It can cause gastroparesis which can lead
to impaired digestion, as well as tooth decay, gum disease, and sexual dysfunction. So there are so many reasons to really take
diabetes seriously and manage it very closely to avoid these complications. Okay. That is it for the endocrine system. So I know there's a lot of videos. There's so many important topics with the
endocrine system. I appreciate you hanging in there with me. I hope you've learned a lot. Be sure to subscribe to our channel, like
this video, and I will see you again on another video soon!
