Diabetes Flashcards
Key teaching points in blood glucose (BG) monitoring
side of finger (hurts less)
clean hands before hand with soap and water (alcohol obstructs reading)
get good enough sample size
timing (when to test BG)
what are their target ranges?
how to calibrate the meter
strips need to be away from oxygen (in dark container)
date of strips expire
dispose of strips and lancets properly
how to clean/charge the machine
squeezing finger too much adds serum to the blood and get bad reading
Exercise
- lowers BG
- if BG over 250 mg/dL plus have ketones in urine don’t exercise
- bring 15g snack when exercising
Nutrition
Goals:
- Keep blood sugars with in normal.
- Attain or maintain a reasonable body weight
- Optimum lipid levels
- BP less than 130/80
- Enough calories to meet metabolic needs.
Insulin Types
Very short acting
Short acting (Regular)
Immediate acting
Long-acting
Very short-acting insulin (aka RAPID acting)
Types: NovoLog and Humalog
Onset: within 10-15 mins.
Peak: 1 hr.
Duration: 3-5 hrs.
Short-acting (REGULAR) insulin
Types: Humulin-R and Novolin-R
Onset: within 10 to 60 mins.
Peak: 2-3 hrs.
Duration: 4-6 hrs.
Immediate-acting insulin (NPH)
Types: NPH aka Humulin-N and Novolin-N
Onset: 2-4 hrs.
Peak: 6-8 hrs.
Duration: 12-16 hrs.
Long-acting insulin
Types: Lantus and Levemir
Onset: 2 hrs.
Peak: not defined
Duration: 24hrs. (20-26 hrs.)
Insulin dose types
Basal insulin - given to return body to normal basal rate of insulin output. (It’s not for the food you eat; it’s for everything else insulin has to do in your body). A Diabetic patient puts out 15-30 units in a 24 hour period; half of that is basal insulin
Correctional insulin - give to correct elevated blood sugar
Nutritional (prandial) insulin - give when pt tries to eat, this type attempts to imitate body’s normal response to eating
Sxs of HypERglycemia
“Hot and dry, sugar high”
- dry skin
- flushing
- frequent urination
- trouble focusing
- HA
- fatigue
- irritability
Sxs of HyPOglycemia
“Cold and clammy, need some candy”
- blood glucose low
- confusion/HA
- irritability
- diaphoresis
- trembling
- slurred speech
- LOC, coma, seizure, death
HYPOglycmia treatment
if responsive, give 15g of carbs, wait 15mins and check BG, then give 15g more of carbs if necessary
if unresponsive in hospital, IV of 25 to 50 mL of D50W
if unresponsive outside hospital, give 1mg glucagon IM and call ambulance
Sxs of DKA
- acidosis
- Kussmal breathing
- fruity breath
- osmotic diuresis/dehydration
- electrolyte loss
- N/V and abdominal pain
- weakness
- hypotension
- lethargy/coma/death
Diagnostic findings of DKA
- Glucose >250
- Serum pH 6.8 -7.3 (Arterial and venous blood must maintain a slightly alkaline pH: arterial blood pH = 7.41 and venous blood pH = 7.36.)
- Low serum bicarb (CO2)
- Serum and urine ketones
- Glucose in the urine
- Abnormal electrolytes
Treatment of DKA
- fluid replacement: initially use NS 500ml to 1L for 2-3 hrs., then use .45%NS. May need 6-10L
- insulin: IV; do hourly glucose checks
- restore electrolytes: insulin carries K into cells so monitor for hypokalemia
- reverse acidosis: done with insulin; change IV fluids to D5W or when BG reaches
Sxs of HHNS
- Very high blood sugars: > 600-800 mg/dL
- Absence of ketosis
- High blood osmolarity > 350
- Dehydration and electrolyte loss
Treatment of HHNS
- Fluid deficit in the adult may be 10 L or more.
- FIRST: fluid replacement- ½ of estimated loss in the first 12 hours
- IV insulin at 10 units/hr. or 0.l U/Kg/hr.
- Monitor electrolytes
Gastroparisis
Sxs:
- early satiety
- N/V
- bloating
- abdominal distention following a meal
- constipation
- diarrhea, nocturnal
- inability to maintain glycemic control
Treatment:
- Diet -Low fat, low residue
- Gastric pacemaker
- Meds:
- —Insulin
- —-metoclopramide (Reglan)
Nephropathy
Prevention:
- Avoid nephrotoxic drugs, contrast dye
- Annual UA w/microalbuminuria, creatinine clearance
- Check microalbumin levels in urine at home
Peripheral Neuropathy
Think foot problems (Diabetic Foot and Charcot Foot Deformity) ..will see:
- Autonomic nerve changes
- Neuropathic pain and paresthesia vs. loss of protective sensation.
- Complicated by vascular changes.
Diabetic Retinopathy
- The leading cause of blindness in the US in ages 24 to 74 years old.
- Risk increases the longer you have diabetes.
- Need to see an ophthalmologist every 6-12 mo.
- Painless loss of vision.
- Prevent with good glucose control
Diabetic Sick Days
- Do not stop taking insulin or oral antidiabetic agents!
- Nutrition/fluids essential!
- Notify PCP if: BG > 300, N/V/Diarrhea persist, fever > 100 F., blood glucose is difficult to control or ketones in urine, abdominal pain or SOA or changes in mentation.
Cardiovascular prob. associated with diabetes
- Resting tachycardia
- Exercise intolerance
- Orthostatic hypotension
- Silent or painless myocardial ischemia and infarction.
Diagnostic criteria for diabetes
- Hemoglobin (glycosylated hemoglobin) A1C . 6.5%
- Fasting blood glucose ≥ 126 mg/dL on two occasions indicates DM
- Casual (random/non-fasting) plasma glucose of >200 mg/dL WITH SYMPTOMS
- Oral glucose tolerance (OGTT) - usually done on pregnant women to test for gestational diabetes. In this the result will be 2-hr plasma glucose ≥ 200 mg/dL
