Assessment and Management of Diabetes Overview (Part 1 and 2) Flashcards
pre diabetes
at risk for developing diabetes if they do not make life style changes
- exercise
- eating healthier
- losing weight
complications
blindness
kidney failure
heart disease
stroke
loss of toes, feet, or legs
type 1
body doesn’t make enough insulin
can develop at any age (normally younger)
no known way to prevent
require insulin
autoimmune
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
risk factors for type 2 diabetes
being overweight
having a family history
being physically inactive
being 45 or older
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
insulin does what
insulin helps glucose enter cells
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
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
type 2 diabetics onset
more vague symptoms
slower onset
do type 1 require insulin
always needed
type 1 diabetic onset
suddenly
diabetic ketoacidosis
3 P’s
hyperglycemia
ketosis
metabolic acidosis
symptoms of type 2
increased thirst
increased urination
feeling tired
blurred vision
more frequent infections
treatment for type 2
- always includes
education
healthy eating
blood glucose monitoring
physical activity
treatment for type 2
- may include
medication
insulin
patient centered care
individualize
learns differently
respect beliefs
meet pt where they are at
assessment and diagnostic findings
- glucose
fasting blood glucose 126mg/dL or more
random glucose exceeding 200mg/dL
HgbA1C >6.5%
gerontological considerations for glucose monitoring
glucose tolerance test
A1C measures what
long term glucose range
90-120 days/3 months
other lab diagnostics
lipid panel: HDL risk, CV stroke
BUN/CR: kidney damage
UA, micro albuminuria: kidney damage
ECG: CV risk
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
