TABLE 7-27 Comparison of Diabetic Complications
Pathophysiology	Major metabolic complication when too little food or too large dose of insulin or hypoglycemic agents administered; interferes with oxygen consumption of nervous tissue	Major metabolic complication in which there is insufficient insulin for metabolism of carbohydrates, fats, and proteins; seen most frequently with the known diabetic by stressors (such as infection, trauma, major illness) that increase insulin needs
Risk factors	Too little food Emotional or added stress Vomiting or diarrhea Added exercise	Insufficient insulin or oral hypoglycémies Noncompliance with dietary instructions Major illness/infections Therapy with steroid administration Trauma, surgery Elevated blood sugar: >200 mg/dL
Assessment	Behavioral change:	Behavioral change:
	Subjective data-nervous, irritable, anxious, confused, disoriented Objective data-abrupt mood changes, psychosis	Subjective data-irritable, confused Objective data-drowsy
	Visual: Subjective data-blurred vision, diplopia Objective data-dilated pupils	Visual: Objective data-eyeballs: soft, sunken
	Skin: Objective data-diaphoresis, pale, cool. clammy, goose bumps (piloerection), tenting	Skin: Objective data-loss of turgor, flushed face, pruritus vulvae
	Vitals: Objective data-tachycardia; palpitations, thready	Vitals: Objective data-respirations: Kussmaul's breath: fruity; BP: hypovolemic shock
	Gastrointestinal: Subjective data-hunger, nausea Objective data-diarrhea, vomiting	Gastrointestinal: Subjective data-increased thirst and hunger, abdominal pain, nausea Objective data-vomiting, diarrhea, dry mucous membrane; lips, tongue: red, parched
	Neurological: Subjective data-headache; lips/tongue: tingling, numbness Objective data-fainting, yawning; speech: incoherent; convulsions; coma	Neurological: Subjective data-headache; irritability; confusion; lethargy, weakness
	Musculoskeletal: Subjective data-weak, fatigue Objective data-trembling	Musculoskeletal: Subjective data-fatigue: general malaise
		Renal:Objective data-polyuria
	Blood sugar: <80 mg/dL	Blood sugar: >130 mg/dL
Analysis/nursing diagnosis	Risk for injury related to deficit of needed glucose Knowledge deficit related to proper dietary intake or proper insulin dosage Altered nutrition, less than body requirements, related to glucose deficiency	Risk for injury related to glucose imbalance Knowledge deficit related to proper balance of diet and insulin dosage
Nursing care plan/ implementation	Goal: provide adequate glucose to reverse hypoglycemia: administer simple sugar stat, PO or IV, glucose paste absorbed in mucous membrane; monitor blood sugar levels; identify events leading to complication Goal: health teaching: how to prevent further episodes (see Diabetes, Health teaching, p. 527); importance of careful monitoring of balance between glucose levels and insulin dosage	Goal: promote normal balance of food and insulin: regular insulin as ordered; IV saline, as ordered; bicarbonate and electrolyte replacements, as ordered; potassium replacements once therapy begins and urine output is adequate Goal: health teaching: diet instructions; desired effects and side effects of prescribed insulin or hypoglycemic agent (onset, peak, and duration of action); importance of recognizing signs of imbalance
Evaluation/outcome criteria	Adheres to diet and correct insulin dosage Adjusts dosage when activity is increased Glucose level 80-120 mg/dL	Serious complications avoided Accepts prescribed diet Takes medication (correct dose and time) Glucose level 80-120 mg/dL

TABLE 7-27 Comparison of Diabetic Complications

Hypoglycemia

Ketoacidosis

Pathophysiology

Major metabolic complication when too little food or too large dose of insulin or hypoglycemic agents administered; interferes with oxygen consumption of nervous tissue

Major metabolic complication in which there is insufficient insulin for metabolism of carbohydrates, fats, and proteins; seen most frequently with the known diabetic by stressors (such as infection, trauma, major illness) that increase insulin needs

Risk factors

Too little food

Emotional or added stress

Vomiting or diarrhea

Added exercise

Insufficient insulin or oral hypoglycémies

Noncompliance with dietary instructions Major illness/infections

Therapy with steroid administration

Trauma, surgery

Elevated blood sugar: >200 mg/dL

Assessment

Behavioral change:

Subjective data-nervous, irritable, anxious, confused, disoriented

Objective data-abrupt mood changes, psychosis

Subjective data-irritable, confused

Objective data-drowsy

Visual:

Subjective data-blurred vision, diplopia

Objective data-dilated pupils

Visual:

Objective data-eyeballs: soft, sunken

Skin:

Objective data-diaphoresis, pale, cool. clammy, goose bumps (piloerection), tenting

Skin:

Objective data-loss of turgor, flushed face, pruritus vulvae

Vitals:

Objective data-tachycardia; palpitations, thready

Vitals:

Objective data-respirations: Kussmaul's breath: fruity; BP: hypovolemic shock

Gastrointestinal:

Subjective data-hunger, nausea

Objective data-diarrhea, vomiting

Gastrointestinal:

Subjective data-increased thirst and hunger, abdominal pain, nausea

Objective data-vomiting, diarrhea, dry mucous membrane; lips, tongue: red, parched

Neurological:

Subjective data-headache; lips/tongue: tingling, numbness

Objective data-fainting, yawning; speech: incoherent; convulsions; coma

Neurological:

Subjective data-headache; irritability; confusion; lethargy, weakness

Musculoskeletal:

Subjective data-weak, fatigue

Objective data-trembling

Musculoskeletal:

Subjective data-fatigue: general malaise

Renal:Objective data-polyuria

Blood sugar: <80 mg/dL

Blood sugar: >130 mg/dL

Analysis/nursing diagnosis

Risk for injury related to deficit of needed glucose

Knowledge deficit related to proper dietary intake or proper insulin dosage

Altered nutrition, less than body requirements, related to glucose deficiency

Risk for injury related to glucose imbalance

Knowledge deficit related to proper balance of diet and insulin dosage

Nursing care plan/ implementation

Goal: provide adequate glucose to reverse hypoglycemia: administer simple sugar stat, PO or IV, glucose paste absorbed in mucous membrane; monitor blood sugar levels; identify events leading to complication

Goal: health teaching: how to prevent further episodes (see Diabetes, Health teaching, p. 527); importance of careful monitoring of balance between glucose levels and insulin dosage

Goal: promote normal balance of food and insulin: regular insulin as ordered; IV saline, as ordered; bicarbonate and electrolyte replacements, as ordered; potassium replacements once therapy begins and urine output is adequate

Goal: health teaching: diet instructions; desired effects and side effects of prescribed insulin or hypoglycemic agent (onset, peak, and duration of action); importance of recognizing signs of imbalance

Evaluation/outcome criteria

Adheres to diet and correct insulin dosage Adjusts dosage when activity is increased

Glucose level 80-120 mg/dL

Serious complications avoided Accepts prescribed diet Takes medication (correct dose and time)

Glucose level 80-120 mg/dL