Diabetes Management Nursing for NCLEX: Type 1, Type 2, DKA & HHS Comparison
Comprehensive NCLEX review of diabetes nursing management. Compare Type 1 and Type 2, DKA vs HHS, and learn key nursing interventions for each.
Diabetes Management: Comprehensive NCLEX Review
Diabetes mellitus is one of the most heavily tested topics on the NCLEX. Understanding the pathophysiology, management, and complications of both Type 1 and Type 2 diabetes is essential for exam success.
Type 1 vs Type 2 Diabetes
Type 1 diabetes is an autoimmune destruction of pancreatic beta cells resulting in absolute insulin deficiency. It typically presents in childhood or adolescence with rapid onset of symptoms: polyuria, polydipsia, polyphagia, and weight loss. Treatment requires lifelong insulin therapy. Type 2 diabetes involves insulin resistance and relative insulin deficiency. It typically presents in adults with gradual onset and is associated with obesity, sedentary lifestyle, and genetic predisposition. Treatment begins with lifestyle modifications and oral medications, with insulin added as the disease progresses.
DKA vs HHS
Diabetic ketoacidosis (DKA) occurs primarily in Type 1 diabetes when the body breaks down fat for energy, producing ketones. Key findings include blood glucose above 300 mg/dL, pH below 7.35, serum bicarbonate below 15 mEq/L, positive ketones, Kussmaul respirations, fruity breath odor, and dehydration. Treatment priorities are IV fluid resuscitation, IV regular insulin drip, and potassium replacement (replace potassium before or with insulin if level is below 3.3 mEq/L). Hyperosmolar hyperglycemic state (HHS) occurs primarily in Type 2 diabetes with extreme hyperglycemia (often above 600 mg/dL), severe dehydration, and altered mental status, but without significant ketosis. Treatment focuses on aggressive fluid replacement and insulin therapy.
Chronic Complications
Microvascular complications include retinopathy (leading cause of blindness), nephropathy (leading cause of end-stage renal disease), and neuropathy (peripheral and autonomic). Macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral arterial disease. Annual screening includes dilated eye exam, urine microalbumin, and comprehensive foot exam.
Patient Education
Teach blood glucose monitoring, insulin administration technique, hypoglycemia recognition and treatment (Rule of 15), sick day management, foot care, and the importance of regular follow-up. Emphasize HbA1c goal of less than 7% for most adults. Practice with our clinical nursing mini-exams and review diabetes management cheat sheets.