The DKA Cascade:
-Insulin is a hormone produced by the beta cells in the ORGAN. Insulin drives ________ from the blood stream into the cells- without sufficient amounts of insulin, ________ builds up in the blood stream (hyperglycemia) while the cells are starved of glucose/energy.
-When the cells are starved of glucose/energy, the body releases counter regulatory ________ hormones (glucagon, epi, cortisol, growth hormone). These hormones do two things that are responsible for DKA
1) The regulatory hormones produce more ________ in attempt to provide energy to the cells by breaking down ________ into glucose. Synthesize glucose from non- carbohydrates such as protein and ________. BUT the cells can't access this glucose anyway because there is no ________ to take it into the cells, so the blood glucose levels continue to rise.
-Kidneys can no longer reabsorb all that glucose so it overflows into urine. Water and electrolytes follow the glucose due to osmosis (osmotic diuresis) which causes the symptom of ________ (increased thirst) and polyuria. The osmotic diuresis leads to the ________ imbalances seen in DKA patient's lab results.
2) The regulatory hormones activate measures to supply alternative fuel for the body by metabolizing ________ into fats (lipolysis).
-The process of metabolizing ________ into fats causes ________ bodies to be released. however, ________ are acidic so as they build up in the blood, they cause it to become more and more acidic eventually causing ________ ________.
-Ketone bodies can fuel the brain because they can cross the ________ ________ ______, unlike fatty acids which cannot.
-The body attempts to restore hemostasis by ridding itself of excess ________ by breathing off the excess co2. This presents as deep labored breathing called ________ breathing. Furthermore, the symptom of ________ smelling breath is due to the release of the Acetone, a ketone body produced by lipolysis.
BIBIT:
-Basal Bolus Insulin Therapy (BBIT) mimics ________ physiological insulin release.
-Basal Insulin is _______ [ _ -_________] insulin and should not be held, including when patient is NPO.
-Bolus Insulin is _ [PLACE _______] acting insulin given to cover CHO intake (meals/snacks. Bolus insulin should be held if NPO.
-Correction Insulin is ________ acting insulin administered to correct unanticipated hyperglyce ANY WORD mia. If no correction dose is required according to the BGL and order, document _ [ _______] in the Emar. Correction insulin can be given with bolus insulin or on its own when patient is NPO. Type of insulin ordered for correction dose must be the same as that ordered for ________ insulin
