Assessment and Management of Diabetes Overview (Part 1 and 2) Flashcards by Lani Manners

pre diabetes

at risk for developing diabetes if they do not make life style changes
- exercise
- eating healthier
- losing weight

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complications

blindness
kidney failure
heart disease
stroke
loss of toes, feet, or legs

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type 1

body doesn’t make enough insulin
can develop at any age (normally younger)
no known way to prevent
require insulin
autoimmune

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type 2

body can’t use insulin properly
cells can become resistant/pancreas cannot produce enough insulin
can develop at any age
most cases can be prevented
could use insulin but not require

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risk factors for type 2 diabetes

being overweight
having a family history
being physically inactive
being 45 or older

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risk factors

family history of diabetes
obesity
race/ethnicity
age
hypertension
previously identified fasting glucose or impaired glucose tolerance
HDL
history of gestational diabetes or delivery of a baby over 9lbs
smoking
A1C

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insulin does what

insulin helps glucose enter cells

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symptoms of hyperglycemia

increased thirst
increased urination
blurry vision
feeling tired
slow healing of cuts or wounds
more frequent infections
weight loss
nausea and vomiting

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3 P’s

polyuria: glucose is dumped into urine which draws in water which leads to dehydration

polydipsia: dehydrated due to increase urination

polyphagia: occurs because the body thinks there is no energy because nothing is entering the cells

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type 2 diabetics onset

more vague symptoms
slower onset

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do type 1 require insulin

always needed

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type 1 diabetic onset

suddenly

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diabetic ketoacidosis

3 P’s
hyperglycemia
ketosis
metabolic acidosis

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symptoms of type 2

increased thirst
increased urination
feeling tired
blurred vision
more frequent infections

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treatment for type 2
- always includes

education
healthy eating
blood glucose monitoring
physical activity

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treatment for type 2
- may include

medication
insulin

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patient centered care

individualize
learns differently
respect beliefs
meet pt where they are at

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assessment and diagnostic findings
- glucose

fasting blood glucose 126mg/dL or more
random glucose exceeding 200mg/dL
HgbA1C >6.5%

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gerontological considerations for glucose monitoring

glucose tolerance test

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A1C measures what

long term glucose range
90-120 days/3 months

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other lab diagnostics

lipid panel: HDL risk, CV stroke
BUN/CR: kidney damage
UA, micro albuminuria: kidney damage
ECG: CV risk

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A1C is it the same for everyone

indvidual goals

five components of diabetic care

nutritional therapy
exercise
monitoring
pharmacological
education

therapeutic goal

to achieve normal blood glucose levels without hypoglycemia while maintaining high quality of life

nutritional therapy

maintain the pleasure of eating, include personal and cultural preferences promote exercise and activity

meal planning

must be considerate of patient preferences - lifestyle, eating times, ethnic and cultural background

if a patient requires insulin they need to have consistency in

amount of carbs and calories and time between meals with addition of snacks essential in prevention of hypoglycemic episodes

diet should consist of

50-60% carbs (whole grains 20-30% fat 10-20% protein 25g/day fiber

what is a glycemic index

how fast they make blood sugar rise

how do we identify high glycemic index

monitor BS after ingestion of certain foods to help identify personal glycemic index to improve glucose control

alcohol

can cause hypo/hyper mixer can cause hyper can still drink in moderation eat before and throughout drinking to prevent hypo decrease awareness when drunk so unaware of hypo/hyper hypo and hyper look similar to drunk

sweeteners

nutritive: calories non nutritive: no calories still contribute tosuagr

labels

refer to dietition

exercise does what to blood sugar

lowers blood sugar

exercise precautions

snack pre/post exercise 15 gram carb with protein frequent BS monitoring

when do we not want patients to exercise

BS greater than 250 ketones do not being until negative ketones and BS normal

gerotinlogic consideration exercise

realistic goals - don't want them to run a marathon

risk of self monitoring

errors lack of compliance

errors with self monitoring

not enough blood alcohol swabs expired strips calibrating lack of compliance

why have lack of compliance with self monitoring

hurts

target range for A1C

less than 7%

A1C measures how long

120 days

methods of delivery

pens, syringe, pump

mixing insulin

clear before cloudy

injection rules

systemic rotation of sites within an autonomic area recommended do not use same exact site more than once in 2-3 weeks if exercising do not inject in limb that will be exercised

oral anti diabetic used by their selves

addition to life style modifications

oral medications

metofmin sulfonylureas

metformin contraindicated

kidney or liver impairment

metformin and in the hospital

normally is discontinued in hospital

metformin and contrast

metformin must be discontinued 48 hours prior to contrast otherwise could lead to kidney failure

sulfonylureas

increased risk for hypoglycemia with elderly beta blockers use may decrease or mask s/s of hypoglycemia

basic survival skills

definition normal BS ranges effects of therapy treatment modalities complications

sick day rules

take insulin or oral anti diabetic agent as usual test blood glucose and urine ketones report elevated BS levels or ketones - increased insulin coverage may be required take liquids more frequently to prevent dehydration consume soft foods six to eight times a day if unable to follow a normal diet report nausea, vomiting, diarrhea to provider

why do we want diabetics to take insulin

because BS goes up when you are sick