• Controls level of blood glucose
• Controls storage of glucose as glycogen in liver
• Moves glocose into muscles, liver, & fat cells

• Metablolizes glucose for energy
• Stimulates storage of glucose in liver & muscle
• Stops release of glucose by liver
• Enhanses storage of dietary fat (adipose)
• Encourages transport of amino acids (proteins) into the cells

• Family History
• Obesity
• Minority Race
• Over 45 years old
• Previously abnormal fasting glucose or glucose tolerance test
• Hypertension
• Low HDL, High Triglyceride levels
• History of gestational diabetes
• Giving birth to baby weighing over 9lbs

• Insulin producing beta cells of pancreas destroyed
• Little to no insulin produced by pancreas
• Uncontrolled glucose production by liver
• Acute onset, but process may be ongoing for years before
• Usually occurs before age 30

• Unknown
• Body's own T-cells attack and destroy pancreatic beta cells
• May be due to combine genetic, immunologic, and viral factors

• Requires insulin injections for life

• Often due to development of resistance to endogenous insulin
• Frequently occurs in individuals with family disposition who are obese and over age of 40.

• Obesity
• Physical inactivity
• High Triglycerides >250mg/dl
• Hypertension

• Pancreatitis
• Cushing's syndrome

• glucocorticoid usage

• Two finding (on seperate days) of one of the following:
  • Symptoms of diabetes plus casual plasma glucose concentration of greater than 200mg/dl (without regard to time since last meal)
  • Fasting blood glucose greater than 126mg/dl (8hrs fasting)
  • Two-hour glucose greater than 200mg/dl with an oral glucose tolerance test (10 to 12 hr fasting)

• Ensure that client has fasted (no food or drink other than water) for the 8hrs prior to the blood draw.
• Antibiabetic medications should be postponed until after the level is drawn.

• Instruct client to consume a balance diet for the 3 days prior to the test.
• Instruct client to fast for the 10 to 12 hrs prior to the test.
• A fasting blood glucose level is drawn at the start of the test.
• The client is then instructed to consume a specified amount of glucouse.
• Blood levels are drawn every 30min for 2hrs.
• Clients must be assessed for hypoglycemia throughout the procedure.

Glycosylated Hemoglobin

(HbA1c)

• The target is 4 - 6%
• HbA1c is the best indicator of average blood glucose level for the past 120 days. 
• Assists in evaluating treatment effectiveness and compliance.

• The target is 90 - 130mg/dl.
• Follow or ensure that the client follows the proper procedure for blood sample collection and use of glucose meter.
• Supplemental short-acting insulin may be prescribed for elevated pre-meal glucose levels.

• Polyuria, jpolydipsia, polyphagia
• Weight Loss
• Fatigue
• Increased frequence of infections
• Rapid onset
• Controlled by exogenous insulin

• Polyuria, Polydipsia, polyphagia
• Obesity
• Fatigue
• Increased frequency of infections
• Grandual onset
• Controlled by oral antidiabetic medications and insulin

• Cool, clammy skin
• Diaphoresis
• Anxiety, irritability, confusion, blurred vision
• Hunger
• General weakness, seizures (severe hypoglycemia)

• Hot, dry skin
• Absense of diaphoresis
• Alert to coma (varies)
• N/V, abdominal pain (w/ketoacidosis)
• Rapid deep respirations (acetone/fruity oder due to ketones)

• Inspect feet daily.  Wash with mild soap & warm water
• Pat dry gently, especially between the toes
• Use mild foot powder (w/cornstarch) on sweaty feet
• Do not use commercial remedies to remove calluses or corns
• Consult podiatrist
• Cut toenails even with rounded contours. Do not cut down corners.
• Best time to cut nail is after bath/shower
• Separate overlapping toes with cotton or lamb's wool
• Avoid open-toe, open-heel shoes.
• Leather shoes preferred over plastic.
• Wear slippers w/soles.
• Do not go barefoot.
• Shake out shoes before putting them on.
• Wear clean, absorbant (cotton or wool) socks or stockings that have not been mended.
• Do not use hot water bottles or heating pads to warm feet.
• Wear socks for warmth.
• Avoid prolonged sitting, standing, and crossing of legs.

• Monitor glucose every 4hrs
• Continue to take insulin or oral antidiabetic agents
• Consume 8oz of sugar-free non-caffeinated liquid every hour to prevent dehydration.
• Meet carbs needed through solid food (if possible), or consume liquids equal to usual carb content.
• Test urine for keones and report if abnormal (should be neg to small.)
• Rest.

• Glucose > 250mg/dl
• Ketones are moderate or large
• Fever
  • > 102
  • does not respond to tylenol
  • lasts more than 12 hours
• Feeling groggy or confused
• Experiencing rapid breathing
• Vomited more than once
• Diarrhea occurs more than five times or for longer than 24hrs
• Unable to keep down liquids
• Illness lasts longer than 2 days

• Check blood glucose
• Threat with 15g of carbs
• Recheck glucose in 15min
• If still, low give 15g more of carbs
• Recheck in 15min
• If blood glucose is normal, take 7g protein (if next meal is >1hr)

• 4oz orange juice
• 2oz grape juice
• 8oz milk

• Encourage oral fluid intake
• Administer insulin as prescribed
• Restrict excercise when blood sugar >250mg/dl
• Test urine for ketones and report if abnormal

• Diet & Excercise first
• Single oral medication second
• Mulitple oral medications third
• Injections later
• May require injections only during periods of acute stress

• Inject glucagon 1mg SQ or IM
• 50% Glucose in H₂O IV given in ER or hospital

• Stimulates liver to release glucose
• Person should awake withing 20min
• May cause nausea
• Follow with concentrated CHO

• Blood sugar 300 - 800+
• Low bicarbonate
• Low pH
• Ketones in blood & urine
• Electrolyte abnormalities

• Potassium
• Insulin causes K to move into cells
• If kidneys are impaired, cannot excrete K

• An acute, life-threatening condition characterized by profound hyperglycemia > 600 mg/dl, dehydration, and an absense of ketosis.

• Administration of fluids
• Administration of insulin

• Older adults
• untreated or undiagnosed type 2

• glucose levels:   DKA = >300      HHNS = > 600
• Potassium:        May increase due to acidosis in DKA
• Ketone levels:    DKA:  Present    HHNS:  Absent
• Serum OmA:     DKA:  High        HHNS:  Very High
• Serum pH:         DKA: Metabolic Acidosis      HHNS:no acidosis

• DKA:
  • Na increases due to water loss
  • K initially low due to diuresis
  • K may increase due to acidosis
• HHNS
  • Na increases due to water loss
  • K low due to diuresis

• Both Increased secondary to dehydration

• Potassium will shift into the cells with insulin therapy. 
• The client will need to be monitored for hypoglycemia
• Make sure urinary output is adequate before administering potassium.

• Admisistration of sodium bicarbonate by slow IV infusion
• Need to monitor K levels because too quick of correction of acidosis can lead to hypokalemia.