Diabetes Mellitus

Case Study: The patient with Diabetes Mellitus 1. This patient has diabetic ketoacidosis (DKA). Her labs would probably indicate: Serum glucose will probably be over 300mg/dL Osmolarity would most likely be high if the patient is dehydrated from polyurea caused by the hyperglycemia. Hyperglycemia itself is a hyperosmotic state. It’s possible that this high blood suger could try to pull fluids from cells, creating an almost isotonic state in the early stages of DKA. In other words, this may not be the best indicator of what is actually going on…it can be variable.
Serum acetone would be high due to the production of ketone bodies (from breakdown of fatty acids for energy) BUN: (increased) > 20mg/dL due to dehydration status Arterial PH: low due to current state of acidosis. Arterial PCO2 would be high. This would stimulate Kussmaul respirations to exhale accumulation of CO2. If this kind of breathing continues it can result in respiratory alkalosis (overcorrection).
This situation is a medical emergency because these changes lead to imbalances in blood PH and electrolyte loss. If potassium levels rise, it can effect the heart, causing dysrhythmias. The brain is not getting needed glucose..This can lead to shock, coma and death. 2. The
This patient will need to be taught that the onset of her regular insulin is going to be about a half an hour. It will peak in about 2-4 hours (after breakfast and again after dinner). The onset of the NPH will be about 1.5 hours after she takes it. It will peak in about 4-12 hours (after lunch and again after dinner: at bedtime). She will need to have a snack before bed to avoid hypoglycemia from the NPH. She should be taught that after injection of insulin it is very important to follow with a meal. For example, breakfast should be eating within a half an hour of taking her morning dose of mixed insulin, because the regular insulin will be starting to take effect at that