Diabetes Flashcards
patho review of type 1
- more common in younger people
- more abrupt onset
- 5-10%
- No endogenous insulin production
- 3 P’s most common symptoms
patho review of type 2
- more common in adults
- can go undiagnosed for years
- insulin resistant
the 3 p’s
- polydipsia: excessive thirst
- polyphagia: excessive hunger
- polyuria: frequent urination
other symptoms of diabetes
- fatigue
- recurrent infections (sick)
- slow wound healing
risk factors of t2
non modifiable
- fam history, over 45, race/ethnicity, had gestational diabetes
modifiable
- physical inactivity, obesity, high bp, high cholesterol
fasting blood glucose
normal below 126 mg/dL
- fast for 8 hours before
casual blood glucose
normal below 200 mg/dL
urine ketones
high ketones associated w hyperglycemia
- medical emergency above 300 mg/dL
lipid profile
hdl will be low
triglycerides and ldls will be high
oral glucose tolerance test
used to test for gestational diabetes
- fasting glucose drawn prior, then consumes glucose, and obtain new glucose after 30 mins for 2 hrs
- fasting should be less than 120
- 1 hr: less than 180
- 2 hr: less than 140
glycosylated hemoglobin (HbA1C)
avg glucose level over 3 mons
- used to diagnosis and evaluate effectiveness of treatment
- normal 4-6%
- greater 6.5% is diabetic, typical goal is 7%
criteria to get diagnosed w diabetes
at least one of the following
- A1C 6.5%+
- fasting level greater than 126
- OGTT 12 hr level of 200 mg/dL
- classic symptom of hyperglycemia
repeat labs to verify
care plan for pre diabetic
impaired glucose tolerance, fasting glucose, or both
- typically no symptoms
- alc: 5.7-6.4%, fasting blood sugar: 100-125, ogtt: 140-199
what to do to treat pre diabetic
- teach
- lifestyle modfications
- monitoring glucose levels, a1c
- monitor for symptoms
- diet modifications
pharmo nursing management
- oral meds started on low does then inc
- oral meds often stopped in hospitals
- hold metformin before procedures
how to treat sick DM pt
- steroids inc bs
- inc body stress which can inc glucose
- inc risk of DKA, HHNS
- stomach virus can dec glucose, still need to take med
teach points for sick DM pt (yellow)
- notify HCP
- monitor bs more frequently
- continue meds
- hydrate
- meet carb needs
- rest
teach points for sick DM pt (red)
- urine ketones
- bs greater than 250
- fever greater than 101.5, not responding to meds
- feeling confused, disoriented, rapid breathing
- persistant nausea, vomit, diarrhea
- cant tolerate liquids
- lasts more than 2 days
frequency of bs checks depends on
- glycemic goals
- types of diabetes
- med regimen
- access to supplies and equip
- pt willingness
nursing management
- mimic bodies normal production
- combine basal w meal time (basal bolus regimen)
- rapid and short acting before meals
- use background insulin once a day
- 4 injections a day –> lantus, levemir or novolog, regular
types of insulin (more details in patho)
- rapid
- regular, short
- intermediate
- long
high alert med, what to do
insulin, always check current glucose levels
- check diet order and intake tolerance
what to know about meds
- insulin peak
- duration of insulin
- signs of hypoglycemia and interventions (assessment, food, drug therapy, etc)
- NPO–> what do I do to give them insulin
teaching points
- teach pt self admin
- pt knows their body better than we
- understand timing of insulin
- understand s/s of hypoglycemia
hypoglycemia and s/s
bs less then 70
s/s: sweating, blurry vision, dizziness, anxiety, hunger, irritable, shakiness, inc heart beat,
treatment for hypoglycemia
- check fsbg
- rule of 15 –> give 15g of simple carbs
- fsbg after 15 mins
- repeat once more if needed, then do further interventions if needed
what happens if pt is unconscious and unable to swallow
IM glucagon
IV D50 (25-50 ml)
hyperglycemia
high bs
- can be caused by illness, infection, self-management issues, stress
manifestation
- weakness, fatigue, blurry vision, headache, N/V/D
- often related to uncontrolled hyperglycemia
treatment for hyperglycemia
- check ketones
- insulin
- drink fluids
- educate on prevention
crisis situation of hyperglycemia
- DKA: diabetic keto acidosis (t1)
- HHS: hyperglycemic hyperosmolar syndrome
insulin pumps
continuous release of subcutaneous insulin infusion to receive continuous basal infusions
- can be inc/dec w bolus if needed
pt care of insulin pumps
- pt require to check blood glucose at least 4 times a day
- using deactivated in hospital
potential problems of insulin pumps
- infection at insertion site
- inc risk for DKA
- cost
microvascular damage
damage to capillaries
- retinopathies: damage to retina
- nephropathies: damage in kidneys
- neuropathies: due damage due to metabolic imbalances
macrovascular damage
damage to large vessels
- coronary artery, peripheral vascular, cerebral vascular
- women and men w diabetes are more likely to have CVD
nursing consideration for neuropathy
pt w diabetes are at high risk in lower extremities, bottom of feet
- loss of protective sensation prevents pt from injury that has occurred
diabetic foot care
- wash feet daily
- pat feet dry, get in between toes
- inspect daily for cuts (irritations)
- use lanonlin to prevent dry skin and cracking
- foot powder on sweaty feet
- clean cuts w mild soap no iodine, alc, adhesive
- report infections
- separate overlapping toes
- only shoes w soles and closed toe
- clean absorbant socks
- no hot water bottles
nutritional considerations for diabetes
balanced, high fiber, low fat, low cholesterol
- carbs: encourage grains, fruits, legumes, milk
- fats: polyunsaturated like fish
- fiber: oats, veggies, beans, whole grains
- protein: intake from meat, egg, fish, nut, beans
- alchohol: limit intake
exercise
- encourage
- exercise can lower bs so check before exercising (below 80 or above 250 don’t exercise)
- exercise after meals
- eat a snack before exercise
- wear medical alert bracelet
what can happen to a diabetic pt in hospital
- stress can inc bs (surgery)
- wound healing is impaired
- high risk of infection
even if bs is controlled at home
integumentary concerns
- diabetic dermopathy: reddish, brown usually on shins
- acanthosis nigricans: brown/black, thickening of skin, often seen in skin folds
- necrobiosis lipoidica diabeticorum: red patches around blood vessels
