DKA in someone who wears an insulin pump commonly occurs because of a disturbance kinked or dislodged tubing or air bubbles in insulin delivery. In addition, patients with scar tissue or lipohypertrophy may place their insulin pump site in an area of poor insulin absorption. After DKA resolves, the patient should resume an insulin pump with a new infusion set, new insertion site, and new reservoir of insulin. Nurses should teach the patient to change injection sites and supplies according to manufacturer recommendations, which typically is every 2 to 3 days.
They also should remind patients to make changes only when they can closely monitor their glycemic control. These patients should have a supply of basal insulin and rapid acting insulin to use via injection if they encounter problems with the pump or supplies. In the meantime, they should use multiple daily insulin injections until the pump can be resumed.
Euglycemic DKA. DKA typically is defined by hyperglycemia, but euglycemic DKA may occur with normal or near-normal blood glucose levels. This is particularly true in cases of pregnant patients; starvation; insulin administration soon before hospital arrival; or those taking SGLT-2 inhibitors, which lower the renal threshold for glucose excretion through the urine. If the patient is taking SGLT-2 inhibitors, the medication should be stopped. Before any scheduled surgery or stressful physical activities, patients should stop taking SGLT-2 inhibitors.
Pregnancy can result in increased insulin resistance, so women with pre-existing diabetes may require more insulin, particularly as their pregnancy progresses. Missing insulin doses or failing to adequately adjust insulin in response to increasing insulin resistance can result in significant hyperglycemia and DKA. Pregnant women with underlying diabetes should have access to ketone strips for self-monitoring.
Treating DKA in pregnancy includes I. DKA is associated with a high rate of stillbirth, so fetal monitoring is recommended. HHS occurs in the presence of hyperglycemia, hyperosmolality, and dehydration but without ketosis. It typically occurs in older individuals with Type 2 diabetes and in those with underlying stressors such as stroke, cardiac disease, or pneumonia.
High carbohydrate intake, such as through tube feeding or I. HHS is caused by a relative lack of insulin paired with inadequate fluid intake, leading to hyperglycemia, which then causes osmotic diuresis and further volume depletion. Lack of ketosis likely is due to only a relative, rather than an absolute, lack of insulin, which reduces the development of ketones. Because HHS typically occurs in older individuals with underlying comorbidities, it has a significantly higher mortality rate than DKA.
Patients may experience several weeks of rising glucose levels, polyuria, polydipsia, and weakness along with a declining mental status. Signs of dehydration including dry mucous membranes , tachycardia, and orthostasis are evident on physical exam. Ketones usually are absent in HHS, although they may be present in a fasting state. However, because of significant dehydration with a free water deficit of several liters, I.
In some cases, fluids alone can significantly reduce blood glucose levels. Unless serum ketosis is present, I. In most cases, 0. As in DKA, standardized insulin protocols for I. In addition, subcutaneous insulin should be continued on initial discharge home before later transitioning back to oral diabetes agents. As in DKA, close, early outpatient follow-up is needed. Fluids and insulin are the mainstays of treatment. As hospital admissions for both conditions continue to increase, early identification and treatment can reduce length of stay and healthcare costs.
In addition, individualized education and improved care coordination can help prevent future admissions. American Diabetes Association. Children and adolescents: Standards of medical care in diabetes— Diabetes Care. Diabetes care in the hospital: Standards of medical care in diabetes— Management of diabetes in pregnancy: Standards of medical care in diabetes— Learn more about the pros and cons of….
An insulin pump is an alternative to giving yourself multiple daily insulin injections. It's mostly used for type 1 diabetes, and has both pros and…. Here's how. Health Conditions Discover Plan Connect. Medically reviewed by Michelle L. Symptom chart. When to seek care. The bottom line. Read this next. Diabetes Risk Factors. Medically reviewed by Maria Prelipcean, M. Medically reviewed by Tyler Walker, MD.
Difference Between Similar Terms and Objects. MLA 8 S, Prabhat. Name required. Email required. Please note: comment moderation is enabled and may delay your comment. There is no need to resubmit your comment. Notify me of followup comments via e-mail. Written by : Prabhat S. MLA 8 J, John. Type I diabetes is not Diabetes Insipidus. SIADH would be an increase in anti-diuretic hormones thus preventing the body from releasing water.
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