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Discharge Teaching For Patient With Dka

Diabetic Ketoacidosistreatment & Management

Diabetic Ketoacidosistreatment & Management

Diabetic KetoacidosisTreatment & Management Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Managing diabetic ketoacidosis (DKA) in an intensive care unit during the first 24-48 hours always is advisable. When treating patients with DKA, the following points must be considered and closely monitored: Correction of fluid loss with intravenous fluids Correction of electrolyte disturbances, particularly potassium loss Treatment of concurrent infection, if present It is essential to maintain extreme vigilance for any concomitant process, such as infection, cerebrovascular accident, myocardial infarction, sepsis, or deep venous thrombosis . It is important to pay close attention to the correction of fluid and electrolyte loss during the first hour of treatment. This always should be followed by gradual correction of hyperglycemia and acidosis. Correction of fluid loss makes the clinical picture clearer and may be sufficient to correct acidosis. The presence of even mild signs of dehydration indicates that at least 3 L of fluid has already been lost. Patients usually are not discharged from the hospital unless they have been able to switch back to their daily insulin regimen without a recurrence of ketosis. When the condition is stable, pH exceeds 7.3, and bicarbonate is greater than 18 mEq/L, the patient is allowed to eat a meal preceded by a subcutaneous (SC) dose of regular insulin. Insulin infusion can be discontinued 30 minutes later. If the patient is still nauseated and cannot eat, dextrose infusion should be continued and regular or ultrashort-acting insulin should be administered SC every 4 hours, according to blood glucose level, while trying to maintain blood glucose values at 100-180 mg/dL. The 2011 JBDS guideline recommends the Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

DKA is usually signaled by high blood sugar levels. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. Diabetic Ketoacidosis (DKA) – a condition brought on by inadequate insulin – is a life-threatening emergency usually affecting people with type 1 diabetes. Although less common, it also can happen when you have type 2 diabetes. DKA is usually, but not always, signaled by high blood sugar levels. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. As a consequence the excess fat goes to the liver and glucose builds up in the bloodstream. The liver makes ketoacids (also known as ketones) out of the fat. Before long, the body is literally poisoning itself with excess glucose and ketoacids. What causes DKA? A lack of insulin usually due to: Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin, or spoiled insulin Infection Steroid medications An extremely stressful medical condition DKA is rare in type 2 diabetes – but can develop if someone with type 2 diabetes gets another serious medical condition. Examples of medical conditions associated with DKA in type 2 diabetes are severe infections, acute pancreatitis (inflammation of the insulin producing organ, the pancreas), and treatment with steroids. Symptoms of DKA include: Nausea, vomiting Stomach pain Fruity breath – the smell of ketoacids Frequent urination Excessive thirst Weakness, fatigue Speech problems, confusion or unconsciousness Heavy, deep breathing How do you know if you have DKA? Check your blood or urine for ketones. And if the test is positive, you will need immediate medical care. Treatment includes agg Continue reading >>

Diabetic Ketoacidosis Discharge Instructions

Diabetic Ketoacidosis Discharge Instructions

Diabetic Ketoacidosis Discharge Instructions Diabetic ketoacidosis or DKA is a serious problem. It may happen when you have high blood sugar that is not treated. Your body needs insulin to use the sugar in your bloodstream. Having the right amount of insulin controls the amount of sugar in your blood. Sugar is in the food you eat. Insulin changes this sugar into energy, which fuels your body. If you do not have the right amount of insulin in your body, it will use fats for energy instead of sugar. Ketones are made after your body uses fats for energy. If you continue to not have enough sugar, then more and more ketones will be made. Ketones poison your body and can be measured in your blood or urine. Using ketones for energy leads to diabetic ketoacidosis , which is a medical emergency. Doctors treat this illness in the hospital by replacing lost fluids and minerals. They will also give you insulin so your body can use sugar for energy. Ask your doctor what you need to do when you go home. Make sure you understand everything the doctor says. This way you will know what you need to do. Learn how to take your own blood sugar and check ketone levels in your urine. Ask your doctor about home kits or if your glucometer can check for ketones. The doctor may want you to use test strips to check your urine for ketones if your blood sugar is higher than 240. Write down your blood sugar and ketone amounts each time you take them. This will help your doctor treat your illness. Wear your medical alert bracelet at all times. Eat at set times and follow a diabetic diet. Control your blood sugar. Know your goal blood sugar ranges. Keep taking your insulin as ordered. If using an insulin pump, check if it works the right way. Your doctor may ask you to make visits to the office to che Continue reading >>

Patient Education In The Hospital

Patient Education In The Hospital

In Brief Recent concern about the optimum management of hyperglycemia for hospital patients has heightened awareness of necessary standards of care. Publications have confirmed that diabetes is not diagnosed or treated when detected in acute care settings, and opportunities for education are missed. Hospitalization presents an opportunity to address patients' unique urgent learning needs. In centers where quality diabetes management is a priority, education is readily available, roles are clear, and quality is monitored, evidence supports the notion that inpatient education is related to earlier discharge and improved outcomes following discharge. From the 1950s (and even earlier) to the 1970s, patients with newly diagnosed type 2 diabetes and certainly those with type 1 diabetes were admitted to the hospital for initiation of medication and nutrition therapy, as well as comprehensive patient education. Given a long stay, nurses and sometimes nurse specialists, along with inpatient dietitians, provided one-to-one instruction with multiple opportunities for patient practice. Group classes were rare in this setting, and outpatient programs were not usually available. Patients were expected to be able to provide “return demonstrations” of concepts and psychomotor skills before discharge. Pre- and post-instruction knowledge tests were the norm. The curriculum was long and detailed, and information was provided through discussions, videotapes, or booklets written for patients.1 Yet incidences of last-minute medication instruction occurred then just as they do today.2 Much of the literature on inpatient diabetes education then focused on the knowledge deficiencies of hospital staff and what to teach newly diagnosed patients.3–7 Continuing education for nurses in the hos Continue reading >>

Management Of Diabetic Ketoacidosis In Adults

Management Of Diabetic Ketoacidosis In Adults

Diabetic ketoacidosis is a potentially life-threatening complication of diabetes, making it a medical emergency. Nurses need to know how to identify and manage it and how to maintain electrolyte balance Continue reading >>

Diabetic Ketoacidosis (dka): Care Instructions

Diabetic Ketoacidosis (dka): Care Instructions

Your Care Instructions Diabetic ketoacidosis (DKA) happens when the body does not have enough insulin and can't get the sugar it needs for energy. When the body can't use sugar for energy, it starts to use fat for energy. This process makes fatty acids called ketones. The ketones build up in the blood and change the chemical balance in your body. This problem can be very dangerous and needs to be treated. Without treatment, it can lead to a coma or death. DKA occurs most often in people with type 1 diabetes. But people with type 2 diabetes also can get it. DKA can be caused by many things. It can happen if you don't take enough insulin. It can also happen if you have an infection or illness like the flu. Sometimes it happens if you are very dehydrated. DKA can only be treated with insulin and fluids. These are often given in a vein (IV). Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take. How can you care for yourself at home? To reduce your chance of ketoacidosis: Take your insulin and other diabetes medicines on time and in the right dose. If an infection caused your DKA and your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. Test your blood sugar before meals and at bedtime or as often as your doctor advises. This is the best way to know when your blood sugar is high so you can treat it early. Watching for symptoms is not as helpful. This is because you may not have symptoms until your blood sugar is very high. Or you may not notice them. Teach others a Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious, life-threatening complication of diabetes mellitus. DKA is characterized by the triad of hyperglycemia, anion gap metabolic acidosis, and ketonemia. It is part of a spectrum of hyperglycemia on which lies hyperosmolar hyperglycemic state (HHS). Though the two are distinct entities, they do share some commonalities. DKA is caused by the reduced effect of insulin, either due to deficit or reduction of levels, with concomitant elevation of counter regulatory hormones (glucagon, catecholamines, cortisol, and growth hormones), generally due to a precipitating stress. Increased gluconeogenesis, glycogenolysis, and decreased glucose uptake by cells leads to hyperglycemia, while insulin deficiency leads to mobilization and oxidization of fatty acids leading to ketogenesis. Although DKA may be the initial manifestation of diabetes, it is typically precipitated by other factors. It is critical for a clinician to identify and treat these factors. Infection can be found in 40-50% of patients with hyperglycemic crisis, with urinary tract infection and pneumonia accounting for the majority of cases. DKA is a life-threatening medical emergency with a mortality rate just under 5% in individuals under 40 years of age, but with a more serious prognosis in the elderly, who have mortality rates over 20%. Deaths may also occur as a result of hypokalemia induced arrhythmias and cerebral edema (more common in children). II. Diagnostic confirmation: are you sure your patient has diabetic ketoacidosis? Although the diagnosis of DKA can be suspected on clinical grounds, confirmation is based on laboratory tests including potential hydrogen (pH) level, urinalysis, and basic metabolic profile. summarizes the biochemical criteria for the diagnosis and asse Continue reading >>

Risk Of Death Following Admission To A Uk Hospital With Diabetic Ketoacidosis

Risk Of Death Following Admission To A Uk Hospital With Diabetic Ketoacidosis

, Volume 59, Issue10 , pp 20822087 | Cite as Risk of death following admission to a UK hospital with diabetic ketoacidosis The aim of this study was to assess the risk of death during hospital admission for diabetic ketoacidosis (DKA) and, subsequently, following discharge. In addition, we aimed to characterise the risk factors for multiple presentations with DKA. We conducted a retrospective cohort study of all DKA admissions between 2007 and 2012 at a university teaching hospital. All patients with type 1 diabetes who were admitted with DKA (628 admissions of 298 individuals) were identified by discharge coding. Clinical, biochemical and mortality data were obtained from electronic patient records and national databases. Follow-up continued until the end of 2014. Compared with patients with a single DKA admission, those with recurrent DKA (more than five episodes) were diagnosed with diabetes at an earlier age (median 14 [interquartile range 923] vs 24 [1634] years, p < 0.001), had higher levels of social deprivation (p = 0.005) and higher HbA1c values (103 [89108] vs 79 [6696] mmol/mol; 11.6% [10.312.0%] vs 9.4% [8.210.9%], p < 0.001), and tended to be younger (25 [2236] vs 31 [2342] years, p = 0.079). Antidepressant use was greater in those with recurrent DKA compared with those with a single episode (47.5% vs 12.6%, p = 0.001). The inpatient DKA mortality rate was no greater than 0.16%. A single episode of DKA was associated with a 5.2% risk of death (4.1 [2.86.0] years of follow-up) compared with 23.4% in those with recurrent DKA admissions (2.4 [2.03.8] years of follow-up) (HR 6.18, p = 0.001). Recurrent DKA is associated with substantial mortality, particularly among young, socially disadvantaged adults with very high HbA1c levels. DeprivationDiabetesDiabetic k Continue reading >>

Chapter 64 - Care Of Patients With Diabetes Mellitus Set 2

Chapter 64 - Care Of Patients With Diabetes Mellitus Set 2

Which explanation best assists a client in differentiating type 1 diabetes from type 2 diabetes? Most clients with type 1 diabetes are born with it. People with type 1 diabetes are often obese. Those with type 2 diabetes make insulin, but in inadequate amounts. Correct People with type 2 diabetes do not develop typical diabetic complications. People with type 2 diabetes make some insulin but in inadequate amounts, or they have resistance to existing insulin. Although type 1 diabetes may occur early in life, it may be caused by immune responses. Obesity is typically associated with type 2 diabetes. People with type 2 diabetes are at risk for complications, especially cardiovascular complications. The nurse receives report on a 52-year-old client with type 2 diabetes: Physical Assessment Diagnostic Findings Provider Prescriptions Lungs clear Glucose 179 mg/dL Regular insulin 8 units if blood glucose 250 to 275 mg/dL and cold to touch Right great toe mottled Hemoglobin A1c 6.9% Regular insulin 10 units if glucose 275 to 300 mg/dL Which complication of diabetes does the nurse report to the provider? A cold, mottled toe may indicate arterial occlusion secondary to arterial occlusive disease or embolization; this must be reported to avoid potential gangrene and amputation. Although one glucose reading is elevated, the hemoglobin A1c indicates successful glucose control over the past 3 months. After the age of 40, reading glasses may be needed due to difficulty in accommodating to close objects. Lungs are clear and no evidence of distress is noted. A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client should be monitored for hypoglycemia at which time? Onset of regular insulin is to 1 hour; peak is 2 to 4 hours. Therefore, 11:00 a.m. is the a Continue reading >>

What You Should Know About Diabetic Ketoacidosis

What You Should Know About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious condition that can occur in diabetes. DKA happens when acidic substances, called ketones, build up in your body. Ketones are formed when your body burns fat for fuel instead of sugar, or glucose. That can happen if you don’t have enough insulin in your body to help you process sugars. Learn more: Ketosis vs. ketoacidosis: What you should know » Left untreated, ketones can build up to dangerous levels. DKA can occur in people who have type 1 or type 2 diabetes, but it’s rare in people with type 2 diabetes. DKA can also develop if you are at risk for diabetes, but have not received a formal diagnosis. It can be the first sign of type 1 diabetes. DKA is a medical emergency. Call your local emergency services immediately if you think you are experiencing DKA. Symptoms of DKA can appear quickly and may include: frequent urination extreme thirst high blood sugar levels high levels of ketones in the urine nausea or vomiting abdominal pain confusion fruity-smelling breath a flushed face fatigue rapid breathing dry mouth and skin It is important to make sure you consult with your doctor if you experience any of these symptoms. If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place. If you think you are experiencing DKA, seek immediate medical help. Learn more: Blood glucose management: Checking for ketones » If you have type 1 diabetes, you should maintain a supply of home urine ketone tests. You can use these to test your ketone levels. A high ketone test result is a symptom of DKA. If you have type 1 diabetes and have a glucometer reading of over 250 milligrams per deciliter twice, you should test your urine for keton Continue reading >>

Diabetic Ketoacidosis Discharge Instructions

Diabetic Ketoacidosis Discharge Instructions

Diabetic Ketoacidosis Discharge Instructions Diabetic ketoacidosis is a serious problem. It may happen when you have high blood sugar and you dont treat it. Your body needs insulin. This controls the amount of sugar in your blood. The food we eat contains sugar. Insulin changes this sugar into energy which is needed by your body. If you do not have the right amount of insulin in your body, it will use fats for energy instead of sugar. Ketones are made after the fat is used for energy. If you continue to not have enough sugar, then more and more ketones will be made. Ketones are an acid that will increase in your blood and show up in your urine. Ketones poison your body. This leads to diabetic ketoacidosis. Doctors treat this illness in the hospital by replacing the lost fluids and minerals. They will also give you insulin so your body can use sugar for energy. Ask your doctor what you need to do when you go home. Make sure you understand everything the doctor says. This way you will know what you need to do. Learn how to take your own blood sugar and check ketone levels in your urine. Ask your doctor about home kits. The doctor may want you to use test strips to check your urine for ketones if your blood sugar is higher than 240. Write down your blood sugar and ketone amounts each time you take them. This will help your doctor while treating your illness. Wear your medical alert bracelet at all times. Eat at set times and follow a diabetic diet. Control your blood sugar. Keep taking your insulin as ordered. If using an insulin pump, check if it works the right way. Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits. You may need to have your blood sugar or other lab tests taken to see if you are having more prob Continue reading >>

Management Of Adult Diabetic Ketoacidosis

Management Of Adult Diabetic Ketoacidosis

Go to: Abstract Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management. Keywords: DKA treatment, insulin, prevention, ESKD Go to: Introduction In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis (DKA) with an average length of stay of 3.4 days.1 The direct and indirect annual cost of DKA hospitalizations is 2.4 billion US dollars. Omission of insulin is the most common precipitant of DKA.2,3 Infections, acute medical illnesses involving the cardiovascular system (myocardial infarction, stroke) and gastrointestinal tract (bleeding, pancreatitis), diseases of the endocrine axis (acromegaly, Cushing’s syndrome), and stress of recent surgical procedures can contribute to the development of DKA by causing dehydration, increase in insulin counter-regulatory hor Continue reading >>

What Is Diabetic Ketoacidosis?

What Is Diabetic Ketoacidosis?

Having diabetes means that there is too much sugar (glucose) in your blood. When you eat food, your body breaks down much of the food into glucose. Your blood carries the glucose to the cells of your body. An organ in your upper belly, called the pancreas, makes and releases a hormone called insulin when it detects glucose. Your body uses insulin to help move the glucose from the bloodstream into the cells for energy. When your body does not make insulin (type 1 diabetes), or has trouble using insulin (type 2 diabetes), glucose cannot get into your cells. The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems. People with type 1 diabetes are at risk for a problem called diabetic ketoacidosis (DKA). It is very rare in people with type 2 diabetes. DKA happens when your body does not have enough insulin to move glucose into your cells, and your body begins to burn fat for energy. The burning of fats causes a build-up of dangerous levels of ketones in the blood. At the same time, sugar also builds up in the blood. DKA is an emergency that must be treated right away. If it is not treated right away, it can cause coma or death. How can I take care of myself when I go home? How long it takes to get better depends on how well you respond to treatment, your overall health, and any complications you may have. The complications of diabetes, including DKA, can be delayed or even prevented by taking care of yourself and maintaining good blood sugar control. Here are some things you should know. Management Know when and how to test your blood sugar. Keep a log of your blood sugar measurements. Your provider will give you a list of your medicines when you leave the hospital. Know your medicines. K Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

WHAT YOU NEED TO KNOW: Diabetic ketoacidosis (DKA) is a life-threatening condition caused by dangerously high blood sugar levels. Your blood sugar levels become high because your body does not have enough insulin. Insulin helps move sugar out of the blood so it can be used for energy. The lack of insulin forces your body to use fat instead of sugar for energy. As fats are broken down, they leave chemicals called ketones that build up in your blood. Ketones are dangerous at high levels. DISCHARGE INSTRUCTIONS: Call 911 for any of the following: You have a seizure. You begin to breathe fast, or are short of breath. You become weak and confused. Seek care immediately if: You are more drowsy than usual. Contact your healthcare provider if: You have fruity, sweet breath. You have severe, new stomach pain and are vomiting. Your blood sugar level is lower or higher than your healthcare provider says it should be. You have ketones in your blood or urine. You have a fever or chills. You are more thirsty than usual. You are urinating more often than usual. You have questions or concerns about your condition or care. Medicines: Insulin and diabetes medicine decreases the amount of sugar in your blood. Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Help prevent DKA: The best way to prevent DKA is to control your diabetes. Ask your healthcare provider for more information on how to manage your diabetes. The following ma Continue reading >>

Type 1 Diabetes And Your Child: Preventing Diabetic Ketoacidosis (dka)

Type 1 Diabetes And Your Child: Preventing Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis (DKA) is a serious complication of diabetes. It can lead to coma or death. A child with DKA has: High blood sugar (hyperglycemia) An imbalance of chemicals in the blood (metabolic acidosis) High levels of ketones in the blood and urine Ketones are the waste product when the body breaks down fat for energy. This happens when there isn't enough insulin and the body isn't able to use sugar (glucose). Ketones can build up in the blood and then in the urine. Ketosis is a warning sign of DKA. DKA is more common in children with type 1 diabetes. But, it can also occur in children with type 2 diabetes. DKA is a medical emergency. If your child has high ketones and symptoms of DKA described below, call 911 or take him or her to the hospital emergency department. What are the causes of DKA? The most common causes of DKA are: Missing a dose of insulin Illness (flu, cold, or infection) An insulin pump that is not working properly Insulin that has expired or has not been stored properly What are the symptoms of DKA? If your child has high ketones in the blood or urine and symptoms of DKA, call 911 or go to the hospital emergency department. Symptoms of DKA include: Nausea Vomiting Fruity-smelling breath Stomach cramps Very dark urine or no urine in 6 hours Fast breathing Thirst or very dry mouth Drowsiness, confusion, or unresponsiveness When to check for ketones Check for ketones in your child's urine or blood as instructed by his or her healthcare provider. In general, check for ketones when your child has any of the above symptoms, or has: Blood sugar above 250 mg/dL. Diarrhea or vomiting. Fever of 100.4?F (38?C) oral or 101.4?F (38.5?C) rectal or higher, or as directed by your child's healthcare provider How to check for ketones Ask your child's healthcare Continue reading >>

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