Care of Pt. with diabetes Flashcards
Glucose
where is it stored
- “Sugar”
- Fuels the cells of our body
- Stored mainly in liver in form of glycogen
- Needs help of Insulin to enter the cells
Insulin
- Hormone which regulates amount of glucose in blood
- Helps body use glucose by allowing it to enter the cell
- Secreted by Beta Cells
Glucagon
- Secreted by Alpha Cells
- Hormone that helps the liver turn stored glucose (glycogen) into glucose
a&p of Increased blood sugar
- Pancreas releases Insulin → Glucose enters cells to be used or saved for later to lower blood sugar
Decreased blood sugar
Pancreas releases Glucagon → Liver releases glycogen (stored glucose) to increase blood sugar
what is diabetes Mellitus
- common, chronic, complex disorder
- results from inability to produce insulin and the bodys resistance to insulin
- results in hyperglycemia
type 1 dm
- autoimmune- destruction of beta cells
- known as juvenille onset or insluin dependdent diabetes mellitus
- onset before 30
- management: dependent on insulin, diet, and exercise
type 2 dm
- progressive disorder: initial resistance to insulin, progresses to decrease secretion
- known as adult onset diabetes or non insulin dependent mellitus
- onset is any age
- Management: diet, exercise, oral hypoglycemics, 20-30% require insulin
3 initial symtoms of dm
- polyuria
- polydipisa- thirst
- polyphagia
polyuria
- increased urination
- Kidneys attempt to filter high blood glucose → Excreted from body in urine
polydipsia
- increased thirst/ drinking
- Increased water consumption to make up from water loss by frequent urination
polyphagia
- increased hunger
- Cells are starved of glucose leads to increased huger/eating
hyperglycemia causes and symptoms
- BG > 115 mg/dL
Causes
- Stress
- Skipped Insulin
- Steroids
Symptoms
- Warm/Dry
- Tachycardia
hypoglycemia causes and symptoms
BG < 70 mg/dL
Causes
- Lack of eating
- Intense exercise
- Too Much Insulin
Symptoms
- Sweating
- Cool/Clammy
- Irritable/Anxious
- Hunger
- Double Vision
Diabetic Ketoacidosis (DKA)
- More Common in Type 1 Diabetics
- Insulin deficiency → Cellular Starvation → Breakdown of Fats → Ketones → Acidotic State
Diabetic Ketoacidosis (DKA) Signs/Symptoms
- Nausea/Vomiting
- Excessive Thirst
- Kussmaul’s Respirations
- Fruity Breath
- Changes in LOC
- Metabolic Acidosis
- BG > 300 mg/dL
Hyperglycemic Hyperosmolar Syndrome (HHS)
- More Common in Type 2 Diabetics
- Insulin deficiency combined with profound dehydration → Blood Glucose Elevation
Hyperglycemic Hyperosmolar Syndrome (HHS) s/s
- Blurred Vision
- Headache
- Changes in Mental - Status
- Seizures
- BG > 600 mg/dL
diagnostic testing for dm
Glycosylated hemoglobin (A1C)
- Identifies average blood glucose over time
- Previous 120 days
- Reference Range 4 – 6%
- Diabetics: 6.5 – 8%
- Preference 7% or less
Fasting Blood Glucose (FBG)
- Two separate results >126 mg/dL
Long term cardio/cerebrovascular disease complications
HTN, MI, Stroke
Nursing
- BP Control, smoking cessation, lipid-lowering medications and ASA
Education
- Cholesterol checks, regular activity, low-fat diet
long term diabetic rentiopathy complications
Impaired Vision, Blindness
Education
- Yearly Eye Exam, report vision changes
long term diabetic neuropathy complications
Peripheral Neuropathy: change in sensation- cant feel
- Most commonly affects feet/lower extremities
Nursing
- Foot care: check every day
- Gabapentin
Education
- Annual podiatrist apt, daily foot inspection/care, report numbness/tingling
long term diabetic nephropathy complications
ESRD/ESKD
- #1 cause of ESRD in US
Nursing
- monitor kidney function, I&Os, report output less than 30ml/hr monitor bp
- diuretics
education
- consume 2-3l of fluid/day, avoid soda, alochol, acetaminophen, NSAIDS, report decreased output
hypoglycemia unconscious
- Place in lateral position – prevents aspiration
Administer
- Glucagon SQ/IM: tells liver to take out sugar out of cell
- D50 or IV Dextrose
hypogylcemia conscious
Provide readily absorbable carb
- 4-6oz fruit juice or regular soft drink
- Glucose tablets/gel
- Hard candies
Recheck 15 Min After Intervention
hyperglycemia action type 2 dm
Oral Hypoglycemics
- Reserved for Type 2 patients
- NOT Insulin
Action:
- Stimulate Pancreas to Produce more Insulin
- Increase Tissue Sensitivity to Insulin
- Slow carbohydrate absorption in intestines
examples of oral hypoglcemics
Metformin – Most Common
- Stop 24-48 hours before imaging with iodinated contrast dye, resume 48 hours after
Glipizide
- When given with beta-blockers can mask tachycardia
insulin
routes
sites
timing
- given for hyperglycemia
Administration Routes
- SQ
- IV
Sites
- Rotate frequently to prevent tissue damage
- Abdominal tissue provides fastest absorption
- Do NOT inject within 2-inches of umbilicus
Timing
- Onset – Time from administration to lowering of BG
- Peak – When insulin is working the hardest
- BG is at its lowest
- Duration – Length of time before all the insulin is used up
Rapid
lispro (humalog)
onset: 15min
Peak: 1-2 hours
duration: 3-4hr
admin time: before or with meals
short
regular (humulin-r)
onset: 30-60 min
peak: 2-4hr
duration: 5-7hr
admin time: 30-60 min before meals
intermediate
NPH (humulin-N)
onset: 2-4hr
peak: 4-10hr
duration: 10-16hr
admin time: between meals or at night
long
lantus (glargine)
onset: 3-4hr
peak: none
Duration: 24 hours
admin time: once a day
non-pharmacological management: nutritonal therapy
- Patient should work with Registered Dietitian/Nutritionist
Carbohydrates
- Limit Simple Sugars
- Stick to Complex Carbs
- Low Fat/Sodium
- Be Consistent
non-pharmacological management: exercise
150 Minutes/Week – Evenly spaced every other day
Precautions
- Check BG before
- exercising
- Eat snack if BG <100 mg/dL
- Carry Fast Snack
- Do NOT admin insulin in areas being exercised
- Affects absorption
what kind of insulin therapy does type 1dm need while npo
- Type 1 diabetics will need continued insulin administration even while NPO
- Preventing DKA
what kind of insulin therapy does type 2dm need while npo
- Type 2 diabetics may have less insulin requirements when NPO or on a clear liquid diet
- Preventing hypoglycemia
when is short acting insulin often given
at the time of clear liquid meals or enteral feedings to prevent hyperglycemia
clients on continous feedings get sugars checked when?
- Clients receiving continuous feedings require blood glucose monitoring at evenly spaced intervals
- Usually every 6 hours
pt. teaching
Ensure
- Ensure patient demonstrates appropriate technique for obtaining fingerstick blood glucose
Determine
- Determine patients understanding of how to respond to results of blood glucose testing
Validate
- Validate the patient can perform correct self administration of insulin
Remind
- Remind patient metabolic demand changes with illness, insulin requirements may change
