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Pathophysiology > Care of Diabetes > Flashcards

Care of Diabetes Flashcards

1
Q

ABCDESSS of Diabetes Care

A 
A - A1c < 7%
B - Blood pressure < 130/80
C - Cholesterol - LDL< 20 mmol/L
D - Drugs (to protect heart)
      A - ACE inhibitors or ARBS
      S - Statins 
      A - Aspirin
E - Exercise and eating healthy 
S - screening for complications 
S - smoking cessation 
S - self management of stress and other barriers to self-care
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2
Q

Why is foot care for people with diabetes so important?

A
  • Neuropathic damage: so they do not have sensation in their extremities and can develop huge ulcers
  • poor circulation so wounds cannot heal
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3
Q

Look for minor trauma

A
  • recognize and treat wounds promptly. Assess CWMSE. Need protein to health wounds, so they need a balance of protein in their diet. Smoking lowers perfusion to lungs
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4
Q

If a wound has ulcerated

A

ensure it is debrided (necrotic tissue is a breeding ground for bacteria)
Administer antibiotics early.
promote circulation (passive ROM, getting up and mobilizing) prevent edema (elevate foot)

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5
Q

Gangrene

A

endstage of a wound that has not been properly treated. Wound is often there because of a combination of pressure on tissue that is not relieved and circulation.

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6
Q

Diabetic Neuropathy: Sensory

A
  • most common
  • paresthesias - burning, prickling sensation
  • hyperesthesia - increased sensitivity to stimulation
  • complete or partial loss of sensitivity to touch & temperature
  • Pain described as burning, cramping, crushing or tearing
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7
Q

Diabetic Neuropathy: Autonomic

A
  • effects all body systems
  • leads to hyperglycemia. bowel incontinence. diarrhea. urinary retention.
  • gastroparesis
  • cardiovascular
  • erectile dysfunction
  • neurogenic bladder
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8
Q

Management of Diabetes

A

Nutrition
Blood glucose monitoring
exercise and stress management
Pharmacological management

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9
Q

Oral antihyperglycemic: Sulfonylureas

A
  • increase beta-cell insulin production
  • some increase cellular insulin sensitivity
  • only type II
  • increase risk of hypoglycemia in older adults & those with renal impairment
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10
Q

Oral antihyperglycemic: Biguanides

A
  • Decrease glucose production by liver
  • increase insulin sensitivity
  • add other medications to it when it has been used for a long time and its no longer having the same effect
  • has beneficial effect on plasma lipid levels
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11
Q

At diagnosis of type 2 diabetes

A
  • start with lifestyle interventions +/- metformin. looking for A1c < 8.5% and if they are not below that in 2-3 months the physician will increase metformin
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12
Q

Insulin: Rapid acting

A

onset: 15-30 minutes

- most behave like pancreas would. patient has to be able to administer insulin and eat immediately

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13
Q

Insulin: short acting

A
  • onset: 30 min
  • Humulin R (sliding scale)
  • can be given QID on sliding scale in hospital
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14
Q

Intermediate acting

A

NPH
Cloudy
Onset: 1-2 hr

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15
Q

Extended long acting

A

Lantis
Onset 90 min
lasts over 24 hr

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16
Q

Educate client on insulin regarding (6):

A
  • timing of insulin and meals
  • insulin syringes and concentrations
  • storage
  • preparation
  • site selection
  • techniques for injection
17
Q

Exercise

A

increase glucose uptake

decrease insulin resistance

18
Q

Stress

A

increases insulin resistance and blood glucose

19
Q

Exercise precautions (5)

A 
SMBG before and after
keep a log of activity and BG
avoid exercise when hypoglycemic
1-2 hr after meal
Carry carbs and medic alert tag
20
Q

Secondary Prevention

A
  • screening every 3 years for people > 40 or those at high risk
  • screen earlier & more frequently in people with additional risk factors for diabetes or those at very high risk
  • Screening for type 2 diabetes - FBG and/or A1c
21
Q

Summary Diabetes Education (7)

A
  • eating healthy
  • regular exercise
  • medications and SMBG
  • routine foot care
  • Sick-day management
  • Developing coping skills and supports
  • utilizing the healthcare system
22
Q

Sick-Day management

A
  • always take insulin and oral diabetic medication
  • if unable to eat regular foods, drink fluids with 10g CHO q1h
  • check urine for ketones
  • check BG levels q4h
  • contact HCP if diarrhea or vomiting > 6h. moderate or large levels of ketones in urine and/or high BG levels
23
Q

Surgery for Diabetic

A
  • need to be on IV sliding scale

- stabilization of BG level prior to, during, and after surgery is key

24
Q

Threats to glucose control Post-Op

A
  1. NPO status
  2. surgical stress that increases BG levels
  3. Complications post-op also increases BG level
25
Q

Postoperative Risks (4)

A
  1. hypoglycemia
  2. electrolyte imbalances
  3. increased wound infection
  4. delayed wound healing

Pathophysiology (8 decks)

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