Ketoacidosis insulin

NIDDM is a much more common disease than IDDM, accounting for about 85—90% of all cases of diabetes meUitus. Whereas NIDDM may be present at any age, the incidence increases dramatically with advanced age over 10% of the population reaching 70 years of age has NIDDM. Patients with NIDDM do not require insulin treatment to maintain life or prevent the spontaneous occurrence of diabetic ketoacidosis. Therefore, NIDDM is frequendy asymptomatic and unrecognized, and diagnosis requires screening for elevations in blood or urinary sugar. Most forms of NIDDM are associated with a family history of the disease, and NIDDM is commonly associated with and exacerbated by obesity. The causes of NIDDM are not well understood and there may be many molecular defects which lead to NIDDM. 

Insulin is necessary for controlling type 1 diabetes mellitus that is caused by a marked decrease in the amount of insulin produced by die pancreas. Insulin is also used to control the more severe and complicated forms of type 2 diabetes mellitus. However, many patients can control type 2 diabetes with diet and exercise alone or with diet, exercise, and an oral antidiabetic drug (see section Oral Antidiabetic Dmgp ). Insulin may also be used in the treatment of severe diabetic ketoacidosis (DKA) or diabetic coma. Insulin is also used in combination with glucose to treat hypokalemia by producing a shift of potassium from die blood and into die cells. 

MANAGING HYPERGLYCEMIA AND KETOACIDOSIS. Capillary blood specimens are obtained and tested in the same manner as for insulin (see Fhtient and Family Teaching Checklist, p. 497). The nurse notifies the health care provider if blood sugar levels are elevated... 

If hypoglycemia develops in the setting of continued ketoacidosis, lower the insulin infusion and administer glucose infusions to maintain euglycemia. Do not stop the insulin infusion... 

Convert to insulin glargine (Lantus ) or NPH SQ insulin (several methods depending on style) once ketoacidosis has resolved and the patient is eating... 

Diabetic ketoacidosis A reversible but life-threatening short-term complication primarily seen in patients with type 1 diabetes caused by the relative or absolute lack of insulin that results in marked ketosis and acidosis. 

Hyperosmolar hyperglycemic state A potentially fatal short-term complication most commonly seen in older patients with type 2 diabetes caused by an insufficiency of insulin action that leads to alterations of osmolality and hyperglycemia, but without the ketosis and acidosis seen in diabetic ketoacidosis. 

Individuals with type 1 DM are often thin and are prone to develop diabetic ketoacidosis if insulin is withheld or under conditions of severe stress with an excess of insulin counterregulatory hormones. 

In patients with type 1 insulin-dependent diabetes mellitus not adequately treated with insulin, fatty add release from adipose tissue and ketone synthesis in the liver exceed the ability of other tissues to metabolize them, and a profound, life-threatening ketoaddosis may ocxnir. An infection or trauma (causing an increase in cortisol or epinephrine) may predpitate an episode of ketoaddosis. Patients with type 2 non-insulin-dependent diabetes meUitus (NIDDM) are much less likely to show ketoaddosis. The basis for this observation is not completely understood, although type 2 disease has a much slower, insidious onset, and insulin resistance in the periphery is usually not complete. Type 2 diabetics can develop ketoacidosis after an infection or trauma. In certain populations with NIDDM, ketoaddosis is much more common than previously appredated. 

Insulin Exenatide is not a substitute for insulin in insulin-requiring patients. Do not use exenatide in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. The concurrent use of exenatide with insulin, thiazolidinediones, D-phenylalanine derivatives, meglitinides, or alpha-glucosidase inhibitors has not been studied. 

Diabetic ketoacidosis, with or without coma (treat with insulin) type 1 diabetes ... 

Severe ketoacidosis/diabetic coma Insulin injection (regular insulin) may be given IV or IM for rapid effect in severe ketoacidosis or diabetic coma. 

Insulin resistance Insulin resistance occurs rarely. Insulin-resistant patients require more than 200 units of insulin/day for more than 2 days in the absence of ketoacidosis or acute infection. 

Diabetic ketoacidosis Diabetic ketoacidosis may result from stress, illness, or insulin omission, or may develop slowly after a long period of insulin control. Hvperglucaqonemia, hyperglycemia, and ketoacidosis may result. ... 

Acute complications During the course of intercurrent complications (eg, ketoacidosis, severe trauma, major surgery, infections, severe diarrhea, nausea, vomiting), supportive therapy with insulin may be necessary. 

Hypersensitivity to sulfonylureas diabetes complicated by ketoacidosis, with or without coma sole therapy of type 1 (insulin-dependent) diabetes mellitus diabetes when complicated by pregnancy. 

Renal disease or renal dysfunction (eg, as suggested by serum creatinine levels greater than or equal to 1.5 mg/dL [males], greater than or equal to 1.4 mg/dL [females], or abnormal Ccr) that may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction (Ml), and septicemia CHF requiring pharmacologic treatment hypersensitivity to metformin acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Treat diabetic ketoacidosis with insulin. 

Patients with type 1 diabetes (previousiy caiied juveniie or insulin-dependent diabetes) have an absolute deficiency of insulin, which produces chronic hyperglycemia (elevated blood glucose) with elevated risk for ketoacidosis and a variety of long-term complications, including retinopathy, neuropathy, nephropathy, and cardiovascular complications. 

In some ways, the metabolic profile of a patient with uncontrolled type 1 diabetes resembles that of the starved patient, except that in the complete absence of Insulin, the ketoacidosis of diabetes is much more severe than in fasting, and starvation is rarely associated with hyperglycemia. 

The answer is C. This patient appears to be suffering from diabetic ketoacidosis induced by his failure to take his insulin on schedule. Although patients with diabetes may have elevated levels of both protein and erythrocytes in urine, depending on the... 

Exercise is an essential yet neglected aspect of treatment for type 2 diabetes especially in its early stages where insulin resistance may predominate. Accumulation of at least 30 0 minutes of moderate physical activity on most days of the week is recommended. For type 1 diabetes the emphasis must be on adjusting the therapeutic regimen to allow safe sports participation to prevent precipitation of ketoacidosis or hypoglycaemia. Extra care is required in cases with known complications like proliferative retinopathy, nephropathy, foot ulcers and cardiac or peripheral vascular disease. 

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