Type 1 diabetes destroys pancreatic beta cells, leaving the body without insulin. DKA happens when cells can't use glucose and burn fat instead, producing fruity breath and deep rapid respirations. Treatment starts with isotonic fluids and insulin, then adds dextrose when blood glucose drops to 250-300 mg/dL.
Your med surg exams and the NCLEX are going to try to trick you on a lot of things. Don't fall for it. In this video, I'm going to walk you through the key things that you need to know about type 1 diabetes so that you can pass your exams. Let's do it. The first thing that a lot of nursing students get wrong is that during type 1 diabetes, the pancreas isn't making any insulin at all. It's none. This is actually caused by an autoimmune disorder where the body itself is destroying the insulin producing cells in the pancreas. Now these are called beta cells. So with these beta cells being destroyed, the pancreas cannot make any insulin. So remember this, in type 1 diabetes, the body isn't making any insulin. So what do you think the treatment would be based around Now? I'll give you a few seconds to think about it. This, this could be fun. You got it. Insulin. We need to get insulin into the body because the pancreas isn't making any itself. So insulin will be a huge part of treatment for patients with type 1 diabetes. If you're a nursing SOS member, be sure to snag the type 1 diabetes study guide that we have for you inside of the membership community. And if you're not a member and you want all of the study guides, of course, course you do. In all the videos to walk you through everything that you need to know to pass med surge in nursing school, you absolutely do not want to miss out on joining the next time enrollment opens. You are going to love it. Now, point number two that you must know about for diabetes for your exams is ketoacidosis. Now I know that's a big scary word. Don't freak out. Here's what it means. When the cells in the body can't use glucose for energy because there's no insulin to get the glucose inside the cells, right? They use fat inst. And when fat is broken down for energy, ketones are produced and ketones are acids. Now we know that the body always wants to stay in balance, right? It doesn't want to swing too far any which way, especially when it comes to the ph. So when all of this fat is broken down, more and more and more ketones are made which are acids and the blood becomes more acidic. And then the more acidic the blood gets, the lower and lower the ph becomes. Now this does not make the body happy, obviously. And this is called acidosis where the blood becomes acidic. So this is ketoacidosis now, there's two things about ketoacidosis that nursing exams love to test you on. Are you ready for this? The first one is fruity breath. Literally, fruity breath. When ketoacidosis makes your breath smell fruity. Now, fruity breath is caused by those ketones being broken down into acetone because acetone smells. Smells fruity. Kind of funny, huh? So that fruity breath is a pretty telltale sign that these ketones are being broken down into acetone because that acetone, it smells fruity. So if the patient's breath smells fruity, they might be in acidosis. Now, the second one you must know is kuzmal respirations, which is a pattern of breathing that is fast and deep. So when the breathing is faster and deeper, more carbon dioxide is released, and carbon dioxide is acid. The lungs try to compensate for the acid buildup of those acidic ketones. They breathe deeper and faster to try to get rid of some of that excess acid. So that is why kuzmal respirations can occur. They are fast and deep respirations. They're trying to get rid of as much acid as possible by getting rid of that carbon dioxide, as much carbon dioxide as they can. Now, the next ones are huge for you to know for your exam. It's all about balancing insulin and fluids and glucose to help your patients come out of ketoacidosis. So type 1 diabetes causes hyperglycemia. Right, because there's so much glucose in the blood and because there's no insulin to move it into the cells. Right. The blood is filled with sugar, so this can cause dehydration. So your patients may need IV fluids to rehydrate. Now, of course, fluid treatment will depend on what the doctor has ordered for the patient and how dehydrated they are. But typically, you will give normal saline, lactated ringers, normal saline, or 5 to 10% dextrose in half normal saline. And there is a specific order that you need to know about for your exams in nursing school, and it depends on your patient's blood sugar level. So, okay, pay attention here, really. So normal saline or lactated ringers is usually given first with insulin because these are isotonic, meaning that they are not going to force fluid any which way those solutions are going to stay, stay inside the blood vessels. So when you think isotonic, think, I so want to stay here. Isotonic, I so want to stay here. Now, as the blood glucose levels drop in the body to around 250-300mg a deciliter you will give 5 to 10% dextrose in half normal saline. Now, this can be confusing. Why would we give glucose when we're trying to drop the patient's blood glucose level with insulin? Great question. Let's talk about it. We do want to drop the patient's blood glucose level with insulin, right? But we don't want to drop it too much. We are trying to control the blood glucose level by giving some more glucose and controlling the rate at which the blood sugar level drops. If we just give normal fluids without glucose plus insulin, that insulin could drop the blood glucose level way too fast. So when the blood glucose level reaches about 250 to 300, 300 milligrams a deciliter, you might give glucose along with those fluids, depending on the doctor's order. So you might see that. Now, of course, a huge, huge thing that you'll need to remember for your exams is what you will need to focus on for your patient. Education, right? So it will be things like teaching your patient how to administer insulin at home, how to monitor their blood glucose level, what the signs are for hypoglycemia and hyperglycemia, what they need to do when they're sick, things like keeping their regular insulin schedule, staying hydrated, and. And then tracking their glucose more often when they are sick. And of course, your exams are really going to try to trick you with all of this stuff. And knowing some really, really powerful exam hacks to help you choose the right answers is going to be crucial. So click on this video where I walk you through those exam hacks and how to pass your exam and choose the correct answer. Check that video out and go become the nurse that God created only you to be, and I'll see you over there in that video.
