What is Diabetes mellitus and What is Medical and nursing management of DKA and HHNS?
Diabetes mellitus is the group of metabolic disorders characterized by elevated levels of blood glucose ( hyperglycemia) resulting from defects insulin secretion, insulin action, or both
Three major acute complications of diabetes related to short-term imbalances in blood glucose levels are:
1. hypoglycemia
2. diabetes keto acidosis(DKA).
3. hyperosmolar nonketotic syndrome (HHNS)
Long-term hyperglycemia may contribute to chronic microvascular complications (kidney and eye disease) and neuropathic complications. Diabetes is also associated with an increased occurrence of macrovascular diseases, including coronary artery disease (myocardial infarction), cerebrovascular disease (stroke), and peripheral vascular disease.
Types of Diabetes.
Type 1 ( Formerly insulin dependent diabetes mellitus).
It is characterized by destruction of pancreatic beta-cells due to genetic, Immunologic, and possibly environmental ( example of viral) factor. Insulin injections are needed to control the blood glucose levels.
1. type 1 diabetes has sudden onset, usually before the age of 30 years.
2. types 2 ( Formerly Non- insulin- dependent diabetes mellitus).
it result from a decreased sensitivity to insulin( insulin resistance) or from a decreased amount of insulin production
Types 2 diabetes is the first treated with diet and exercise, and then with oral hypoglycemic agents as needed.
Type 2 diabetes occur most frequently in the patient older than 30 years and in patients with obesity.
Gestational diabetes mellitus.
Gestational diabetes is characterized by any degree of glucose intolerance with onset during pregnancy( second or third trimester).
Risks for gestational diabetes include marked obesity, a persona; history of gestational diabetes glycosuria, or a strong family history of diabetes.
Clinical manifestations
1. Polyuria, polydipsia, and polyphagia.
2. Fatigue and weakness, sudden vision changes, tingling or numbness in hand or feet, dry skin, skin lesions or wounds that are slow to heal and recurrent infections.
3. Onset of type 1 diabetes may be associated with sudden weight loss or nausea, vomiting, or stomach pains.
4. Onset of type 1 diabetes may be associated with sudden weight loss or nausea, vomiting, or stomach pains.
5. Type 2 diabetes results from a slow (over years), progressive glucose intolerance and results in long-term complications if diabetes goes undetected for many years .
Complications may have developed before the actual diagnosis is made. Signs and symptoms of DKA include Abdominal pain, Nausea, Vomiting, Hyperventilation, and fruity breath odor. Untreated DKA may result in altered level of consciousness, coma, and death.
Assessment and diagnostic methods.
High blood glucose levels: fasting plasma glucose levels 126mg/dL or more, random plasma glucose or 2 hour post load glucose level more than 200 mg/dL.
Prevention.
For the patients who are obese (especially those with type 2 diabetes), weight loss is key to treatment and the major preventive factor for development of diabetes.
Complications of Diabetes.
Complications associated with diabetes are classified as acute and chronic. Acute Complication occur from short- term imbalances in blood glucose and include the following:
1. Hypoglycemia
2. DKA(diabetes keto acidosis).
3. HHNS(hyperglycemic hyperosmolar state).
Chronic complications generally occur 10 to 15 years after the onset of diabetes mellitus.
The complication may include the following:
DKA Complication
Cerebral edema: this is a rare but serious complication especially in children and young adults. it occurs when fluid shifts into the brain, causing and swelling and potentially leading to seizures, coma, and even death.
Acute kidney injury: DKA can lead to dehydration and electrolytes imbalances, which can damage the kidneys.
Pancreatitis: in some cases, DKA can trigger pancreatitis, an inflammation of the pancreas.
Cardiac complications: Severe DKA can lead to heart problems, such as arrhythmias( irregular heartbeats) or heart failure.
HHNS Complications
Dehydration: severe dehydration associated with HHNS can lead to kidney Failure, seizures, and coma.
Electrolyte imbalances: HHNS can cause imbalance in electrolytes like potassium and sodium, which can lead to heart problems and neurological complications.
Blood clots: Dehydration and inflammation associated with HHNS can increase the risk of blood clots, which can lead to stroke or heart attack.
Pulmonary Edema: In severe cases, fluid can accumulate in the lungs, leading to difficulty breathing.
Both DKA and HHNS can also lead to serious complication which are
Coma : If left untreated, both conditions can lead to coma, a state of unconsciousness.
Death: in severe case, both DKA and HHNS can be fatal if not treated promptly.