diabetes Flashcards
Clinical manifestations of Type 1 / Type 2 diabetes
Polyuria, polydipsia , polyphasia , blurred vision, delayed wound healing, Lethargy, warm dry skin , confusion , drowsiness
5 components of diabetic Management
Education , Exercise , Nutrition, Pharmacology, Monitor Glucose levels
Rapid Acting insulin (Lisopro , Aspart, Glulisine)
Give with every meal
Onset : 15-30 mins
Peak : 30 mins -1hr
Duration : 3-5hrs
ONLY -Insulin Pump
Can be mixed with NPH
Short acting insulin
Regular
Onset:30-60 mins
Peak: 2-3 hrs
Duration: 4-6
15 mins before meals
May be taken alone or in combination with Long acting insulin (Glargine determine)
Intermediate acting insulin (NPH-nuetral protamine Hagedorn)
Food should be taken around the peak and onset
Onset: 1-1-5h
Peak: 4-12hr
Duration :24hr
Short or Rapid insulin
HAVE CARBS ON BOARD
Long acting insulin (Glargine determine)
Used for basal dose
NO PEAK - continuous ,- mimic insulin not enough to cover carbs
Onset: 3-6hrs
Duration :24hrs
Rapid acting inhalar (Afrezza)
onset: 15 mins
Peak :50 mins
Duration 2-3hr
administer at the beginning of meals
Insulin Education !
1.Store in the fridge as needed
2. should not be in clumps
3. know needle and gauge size
4. Rotate injection sites
5. Dispose of sharps Plastics ,bottles , Cans
6. use Heavy Duty at home sharps - bleach bottle
7.Insulin pump rotate every 3 days
8. Exercise
Normal/Elevated glucose at bedtime, Early morning Hypoglycemia. Treat by eating late night snack/Decreasing predinner or bedtime dose of intermediate acting insulin. (Carbs and protein before bed).
Somoygi effect
Normal glucose until early morning hours when levels begin to rise. Treated by changing time of injection of evening intermediate acting insulin from dinnertime to bedtime.
Dawn Phenomenon (Acute )
Progressive rise in blood glucose from bedtime to morning. Treated by increasing evening dose of intermediate or long acting insulin or instituting a dose of insulin before the evening meal if one is not already part of the treatment regimen.
Insulin Wanning (Gradual)
Local vs Systemic allergic reaction
❖ Insulin Lipodystrophy
❖ Hypo
❖ Hyper
❖ Insulin Resistance (may require higher doses)
Complications of insulin
❖ Management - easily corrected
❖ Assess patient
❖ Ask questions
❖ Educate: diet, medication, exercise
Hypoglycemia (FATAL)- serious acute complication to be discussed separately
Hypoglycemia:
❖ Occurs when blood glucose drops below 70mg/dL
❖ Too much insulin or oral hypoglycemic medications (Decreases Glucose)
❖ Not enough glucose/carbs
❖ Inadequate food intake
❖ Increased physical activity
❖ Big concern for older adults
❖ Live alone and unaware/unable to recognize hypoG symptoms
❖ Decreased kidney function – longer to excrete oral diabetic meds
❖ Decreased food intake or skipping meals
❖ Decreased visual acuity – errors in insulin administration
Diabetes :Acute complications
(55-70) – sympathetic nervous system activates
❖ Hungry, Diaphoretic, tachycardia, tremors, anxious/nervous
Clinical Manifestations: Hypoglycemia : Mild
: 30-40 blood glucose drop due to the brain
❖ Inability to concentrate, confusion, slurred speech, irritability, combative, drowsiness
Clinical Manifestations: Hypoglycemia :Moderate
❖ CNS function impairment
❖ Disoriented behavior, seizures, difficulty arousing from sleep, or loss of consciousness. (Know ability to swallow/If they cannot swallow, they will need IV treatment)
❖ Patient will need assistance with treatment
Clinical manifestations: Hypoglycemia:Severe
❖ Relative hypoglycemia – sudden drop in glucose levels
❖ Hypoglycemia unawareness – unaware of drop in glucose (Alters ability to drive/use equipment)
❖ Frequent SMBG (Self-Monitoring Blood Glucose) key to management
❖ **Especially before driving or dangerous activities
Assessment/Diagnostics: Hypoglycemia
❖ What priority action should the nurse take if patient’s blood glucose is 64, but patient is not exhibiting any symptoms of hypoglycemia?
Test Blood glucose again
Hypoglycemia Management:
❖ All about them CARBS! About them Carbs! No Hypo!!
❖ 15-20g fast-acting concentrated carbohydrate food/liquid sources
❖ 4 oz juice/non-diabetic soft drink (Dr. Pepper/Coke)
❖ 6 – 10 Hard candy
❖ Diabetic glucose tablets/gel – per package instructions
❖ 1 tbsp Honey
Hypoglycemia Management
Hypoglycemia: Key Considerations in Management:
❖ Prevention is Key!
❖ Educate! Educate! Educate!
➢ Diet, Exercise, Medications
❖ Importance of Diabetic ID bracelet/tag
❖ Educate not only patients, but family and co-workers to recognize s/s of hypoglycemia
❖ Symptoms may be masked
➢ neuropathy
➢ beta-blockers (propanolol)
❖ Oral anti-diabetic sulfonylurea - known to cause prolonged and severe hypoglycemia
❖ Need for frequent SMBG or CGM
❖ Need for carbohydrate source available
❖ Hypoglycemia is not the time to treat with high-calorie, high-fat dessert.
Hypoglycemia: Key Considerations in Management:
rare condition characterized by an abnormal or complete loss of body fat
❖ Insulin Lipodystrophy
