MEDSURG | Diabetes

🧪 DIABETES MELLITUS (DM)

Patho: • T1DM: Autoimmune β-cell loss → absolute insulin ↓ → ketosis prone. • T2DM: Insulin resistance + relative insulin ↓; ketosis rare (stress/infection). • Prediabetes: IFG 100–125; IGT 140–199 (OGTT).

Meds (need-to-know): • Insulin: Rapid lispro/aspart (≤15 min pre-meal); regular (30–45 min pre-meal); long-acting glargine/detemir/degludec (don’t mix). • Metformin: 1st-line T2DM; hold 24–48h pre & ≥48h post iodinated contrast. • SUs: glipi/glyburide/glime—hypoglycemia; take 30 min before meals. • SGLT2i: empa/dapa/cana—UTI/genital infections; hydrate after dose.

Acute priorities: • Hypoglycemia (<70): Rule of 15 → 15 g fast CHO, recheck 15 min; repeat PRN. If NPO/LOC: IM glucagon or IV D50. • DKA (T1): Kussmaul, fruity breath, ketones. • HHS (T2): Glu >600, severe dehydration, neuro changes. → 1st: fluids (0.9% NS), then IV regular insulin; replace K⁺ as indicated; add D5 when BG ≈250 (DKA)/300 (HHS).

Chronic care: A1C goal <7% (often 6.5–7); rotate sites (abdomen fastest); daily feet check; annual eye/foot; store insulin room temp ≤4 wks.

Quick cues: • Contrast? Hold metformin. • DKA triad: BG>250, pH<7.30, HCO₃<16 + ketones. • Exercise (T1): Avoid vigorous if BG ≥250 and ketones.