Diabetes Flashcards
3Ps of clinical presentation for Type 1
Polyphagia (hunger), polyuria (pee), polydipsia (thirst)
Microvascular complications
Damaged capillaries, retinopathies, nephropathies, neuropathies
Macrovascular complications
Damage to big vessels, coronary artery, peripheral artery, atherosclersos, CAD, PVD, stroke, increased risk of infection
When is basal (long-acting) insulin often given?
Before bed
How do steroids affect blood sugar?
Increase—may need to alter insulin schedule
How does being sick affect diabetics?
Body is under more stress, need to check sugar more often, more prone to DKA, HHNS, may not eat or drink normal
How does exercise affect blood sugar?
Can help decrease blood glucose levels; intense exercise could lead to hypoglycemia
Diabetes symptoms
Fatigue, recurrent infection, slow wound healing
Fasting blood glucose
No food or drink for 8 hours before; normal is less than 126
Casual blood glucose
Randomly taken; Normal is under 200 for diabetics (over 300 is a medical emergency)
Urine ketones test
High ketones are associated with hyperglycemia
Lipid profile
High LDL and TGs and low HDL are associated with DM
Oral glucose tolerance test (OGTT)
Common for gestational diabetes; fasting glucose is drawn prior, client consumes oral glucose, glucose levels are obtained q30 minutes for 2 hours; diabetes indicated by over 200 after 2 hours (should be under 110 at 30 minutes, under 180 at 1 hour, under 140 at 2 hours)
Glycosylated hemoglobin (HbA1C)
3 month average of glucose; used for diagnosis and to measure effectiveness of interventions, normal is 4-6%; diabetic is over 6.5%
Diagnostic criteria for diabetes
A1C over 6.5%, fasting level over 126 mg/dL, OGTT 2h level over 200 mg/dL, hyperglycemia symptoms (3Ps), random glucose over 200, or hyperglycemia crisis
How is type 1 diabetes diagnosed?
Islet cell autoantibody test
Pre-diabetic
Impaired glucose tolerance, impaired fasting-glucose, or both
DM
Metabolic disorder characterized by increased blood sugar and a problem with insulin secretion, insulin action, or both
Diagnostics for pre-diabetic patient
A1C 5.7-6.4%, fasting BS 100-125, OGTT 2h BS 140-199
Nursing education for pre-diabetic patients
Teach lifestyle mods, close monitoring of BS and A1C, watch sx (fatigue, frequently sick), diet, want to wait on oral meds but start low and gradually increase based on A1C and fasting glucose
What happens to diabetic meds in the hospital?
Often are stopped taking bc want to just use insulin bc can monitor BS more closely
When DM pt is sick
Tell HCP, watch BS more often, keep taking meds, drink fluids, meet carb needs (Gatorade/Pedialyte)
When should diabetics call HCP?
Urine ketones, BS over 250, fever over 101.5 and Tylenol not working, ill longer than 2 days, can’t tolerate liquids, persistent N/V/D, confused, disoriented, breathing fast
What does the frequency of BS checks depend on?
Glycemic goals, T1 or T2, meds, access to supplies, willingness to
Self-monitoring BS is…
CRITICAL
How is insulin given on a regular basis?
Basal-bolus regimen; long-acting basal (glargine) insulin at bedtime and rapid/short-acting (lispro/human regular) before each meal
Insulin is a high alert med
ALWAYS check current level and ALWAYS check diet order and pt oral intake tolerance before giving
Hypoglycemia
BS below 70 (may have sx above 70)
Hypoglycemia sx
Sweaty, blurry vision, dizzy, anxiety, hunger, irritable, shaky, fast heart rate , headache, weak, fatigue
Tx for hypoglycemia
Rule of 15 (if can swallow)—15g single carbs (ie 4oz juice, 3 glucose tabs, avoiding sugar with fat, BS will increase 50 mg/dL); check BS after 15 minutes then eat normal meal or give carbs again if still low; IM glucagon or IV D50 (25-50 mL)
Hyperglycemia
Caused by illness, infection, self-management problems, stress; can lead to a crisis situation of diabetic ketoacidosis (DKA) or HHNS
Hyperglycemia symptoms
Weakness, fatigue, blurred vision, headache, N/V/D
Hyperglycemia tx
Check for urine ketones, insulin, drink fluids, education and prevention
Insulin pump s
Usually rapid acting or regular; continuous release of SQ basal infusion; can be increased or decreased, can get bolus based on FSBG; pt required to check BS 4x/day; often deactivated in hospital and switch to sliding scale
Problems with insulin pumps
Infection at insertion site, increased risk of DKA if pump malfunctions, cost (not always covered)
Macrovascular disease and nursing implications
Inc risk of CVD with diabetes; educate, stop smoking, control BP, diet mods
Microvascular disease and nursing implications
Retinopathy, neuropathy, nephronopathy; frequent eye exams, increased risk of damage to lower extremities—ulcers and amputations; loss of protective sensation (LOPS)—don’t know injury occurred; check feet or have others check
Diabetic foot care
Wash with soap and water, inspect and pat dry, apply lanolin to feet and mild powder to sweaty toes, clean cuts with soap and water, don’t remove corns or calluses, report nonhealing infections, trim nails after shower and trim across, separate overlapping toes with cotton, wear stable, encompassing shoes and shake before wearing, wear clean, absorbent socks, no hot water bottles
Nutrition for diabetes
High fiber, low fat, low cholesterol; encourage complex carbs and limit simple carbs; diet low in saturated and trans fat; fibrous foods like beans, veg, oats, whole grains; protein—meat, eggs, fish, nuts, beans; 1 daily alc for women and 2 for men
Exercise for diabetics
Proper footwear; exercise after meals and check sugar every 30 minutes if vigorously exercising; don’t exercise under 80 or above 250; eat a carb if planning to exercise hard and carry carb snack with you; wear medical alert bracelet
Nursing for hospitalized diabetics
Stress/surg can increase BP (often becomes uncontrolled); impaired wound healing, high risk of infection
Integumentary concerns for diabetes
Diabetic dermopathy—reddish brown spots on skin; acanthosis nigricans—brown/black thickened skin in folds; necrobiosis lipoidica diabetics rum—red patch around BVs
