Comparison of Acute Complications of Diabetes
Hypoglycemia Diabetic Ketoacidosis Hyperosmolar Hyperglycemic Nonketotic syndrome
Clinical Manifestations
Diagnostic Data
Interventions
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Patient Teaching
Fill out the Table below comparing the Acute Complications of Diabetes.
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List Clinical Manifestations that may be observed.
Indicates diagnostic Data used to monitor the exemplar.
Identify nursing and medical interventions that may be used to treat the exemplar, Including medications.
Identify patient teaching for patients with the conditions.
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Comparison of Acute Complications of Diabetes
Hypoglycemia Diabetic Ketoacidosis (DKA) Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Clinical Manifestations Shakiness, dizziness, sweating, confusion, irritability, hunger, weakness, blurred vision, headache, difficulty concentrating, seizures, loss of consciousness (severe cases) Polyuria, polydipsia, fruity breath odor, nausea and vomiting, abdominal pain, rapid deep breathing (Kussmaul respirations), flushed skin, dry mouth and lips, confusion, weakness, fatigue, blurred vision Extreme thirst, dry mouth, extreme dehydration, frequent urination, weakness, lethargy, confusion, visual disturbances, seizures, coma
Diagnostic Data Blood glucose level <70 mg/dL Blood glucose level >250 mg/dL, arterial blood gas analysis (metabolic acidosis, low bicarbonate), urine ketone testing, elevated blood ketones (beta-hydroxybutyrate) Blood glucose level >600 mg/dL, arterial blood gas analysis (metabolic acidosis, high bicarbonate), urine ketone testing (negative), elevated serum osmolality, elevated serum sodium
Interventions Administer 15-20 grams of fast-acting carbohydrate (e.g., glucose tablets, fruit juice), monitor blood glucose level, administer glucagon injection (severe cases) Administer regular insulin via intravenous infusion, provide fluid and electrolyte replacement therapy, monitor blood glucose, electrolytes, and acid-base balance, administer bicarbonate (in certain cases), treat underlying cause Administer regular insulin via intravenous infusion, provide fluid and electrolyte replacement therapy, monitor blood glucose, electrolytes, and acid-base balance, treat underlying cause
Medications Glucose tablets, fruit juice, glucagon (severe cases) Regular insulin (intravenous infusion), bicarbonate (in certain cases) Regular insulin (intravenous infusion)
Patient Teaching Recognize the signs and symptoms of hypoglycemia, check blood glucose regularly, have a source of fast-acting carbohydrates available, inform family, friends, and coworkers about hypoglycemia and its management Recognize the signs and symptoms of DKA, monitor blood glucose regularly, adhere to prescribed insulin regimen, maintain hydration and electrolyte balance, seek medical attention promptly Recognize the signs and symptoms of HHNS, monitor blood glucose regularly, adhere to prescribed insulin regimen, maintain hydration, seek medical attention promptly
Citations and references:
American Diabetes Association. (2020). Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement 1), S1-S212. Link
Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 32(7), 1335-1343. Link
Pasquel, F. J., Umpierrez, G. E., & Gianchandani, R. (2020). Management of hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Medical Clinics, 104(5), 975-990. [Link](https://www.ncbi.nlm.nih.gov/pmc/articles