DIABETES MELLITUS

INSULIN PUMPS

HYPOGLYCAEMIA
BGL falls below < 50-60 mg/ dl
CAUSES:
TOO much insulin or OHA Too little food Excessive physical activity Occur any time ,before meals, when insulin or OHA at its peak action CLINICAL MANIFESTATION Adrenergic symptoms CNS symptoms

BGL falls
SNS stimulated surge of epinephrine/norepi

Sweating Tremor Tachycardia Palpitation Nervousness hunger

Moderate hypoglycaemia
s/s of impaired function of CNS
Inability to concentrate Headache Lightheadness Confusion Memory lapses Numbness of lips & tongue Slurred speech Impaired cordination Emotional changes Double vision drowsiness

Severe hypoglycaemia
Disoriented behaviour Seizure Difficulty arousing from sleep LOC

DIAGNOSTIC FINDING History ,PE BGL stat Management

15gm of fast acting concentrated source of CHO given orally .3 or 4 commercially prepared glucose tablets 4-6 oz of fruit juice 6-10 hard candies 2-3 teaspoon of sugar or honey Retest in 15 mts & retreat if BGL < 70-75 mg/dl Once resolved snack containing CHO & protein (milk or cheese& crackers)if next meal longer than 1 hr away

Emergency management
Pt if unconscious & cannot swallow
Injection of glucagon 1mg s/c or Im After this a conc CHO followed by snack to prevent recurrence

In hospital
25-50 ml of 5% dextrose IV

Patient teaching
Snack during peak hours Add food before exercise Routine BGL Taught s/s of hypoglycaemia Carry food (glucose tab/ gel )

DIABETIC KETOACIDOSIS
Profound deficiency of insulin & is characterized by hyperglycaemia,ketosis,acidosis,dehydration PRECIPITATING FACTORS Illness & infection Inadequate insulin dosage Undiagonised type 1 DM Poor self management ,neglect

PATHOPHYSIOLOGY
Islets of langerhans

Beta cell destruction Insulin deficiency

Decrease utilisation of glucose by Muscle,fat & liver increase production of glucose by liver

break down of fat increase fatty acids increase ketone bodies .acetone breath .poor appetite,nausea acidosis nausea,vomiting abdomonal pain increasingly rapid respiration

hyperglycaemia blurred vision polyuria dehydration weakness,headahe

thrist (polydipsia)

Clinical manifestation
Polyuria Polydipsia Blurred vision Weakness Headache Orthostatic hypotension Hypotension with weak rapid pulse Ketosis & acidosis of DKA GI SYMPTOMS n,v ,abd pain ,anorexia Acetone breath (a fruity odor Hyperventilation Pt may be alert ,lethargic or comatose