DIABETES Flashcards
One out of how many people in Maine have diabetes?
1 out of 10!!
What are the goals when treating a diabetic patient in-patient?
Avoid hypoglycemia, avoid severe hyperglycemia, assess patient education (always address gaps!)
Glucose levels less than 70 are associated with what?
Highest incidence of complications
Arrhythmias, delirium (encephalopathy), aspiration events, and falls
What two medications most often cause hypoglycemia?
Sulfonylureas (Glipizide & Glyburides – the i’s)
Sliding scales
Intensive insulin therapy (critical care)
In a patient that is not critically ill; what are our glucose goals before meals? Fasting? Random?
Pre-meal = less than 140
Fasting = no lower than 90
Avg. random = less than 180
If we prescribe a sulfonylureas, what specific nursing orders should we write in the hospital?
Hold if poor PO intake anticipated
If a sliding scale system is used in a hospital setting, what must you remember?
Don’t set it and forget it! You must continue to CLOESLY monitor BG levels, especially perioperatively and with unpredictable PO intake
The nurse calls you because the patient is hypoglycemic, what do you do? (3)
Prevent it!
Asymptomatic or mildly symptomatic = 20g oral glucose (glucose tabs, juice or milk, snack or full meal)
If they can’t take by oral → One amp of D50 (dextrose) (follow with PO intake if safe)
*You can keep repeating these doses
How do we avoid severe hyperglycemia?
Keep it less than 180!!
ADA diet order
PO meds often HELD (associated with sulf, renal failure, lactic acidosis with contrast + Metformin, and TZD’s)
Insulin
What do we always hold the moment a patient comes into the hospital in case they need imaging with contrast?
Metformin!
Why do we need to avoid severe hyperglycemia?
Increased risk of infection, volume depletion (dehydration → renal failure), and caloric/protein loss → poor healing
Sliding scale is associated with what type of medication? How often do we check BG with a sliding scale?
Lispro or Aspart
3-4 x/day
**No REGULAR insulin
If a patients BG has a BG of 279 – how many units do we give?
2
If a patient BG is 225 – how many units do we give?
1
BG is 320 – how many units do we give?
3
BG is 380 – how many units?
4
What is a correctional insulin plan generally involve?
Basal bolus insulin + Scheduled Insulin
insulin drags glucose out of the blood and puts it where?
Muscles, LIVER, and fat
What is a common insulin regimen for hospitalized patients?
Basal insulin (lantus or glargine) + Scheduled short acting + Sliding scale
How do you build your insulin coverage?
Calculate total daily insulin requirement (0.5-1unit/kg)
Split the total daily insulin = 50% for basal (one dose = lantus or glargine) + 50% short acting (Aspart or Lispro)
Then divide the short acting over the day (3x = before each meal)
What’s the difference between sliding scale & scheduled?
Scheduled you ALWAYS get it
Sliding = chasing it (hopefully with scheduled regimen we won’t need sliding scale so order it PRN)
How do you adjust the long acting insulin?
Based off the FASTING AM GLUCOSE to no lower than 90
How do you adjust the short acting insulin?
Adjust (up) to meet the less than 180 avg pre-meal glucose goal (to avoid triggering the sliding scale)
How do you assess for education and logistical barriers?
Insurances
Local pharmacy access
Equipment
Sustainability
What other team members can we utilize for diabetes education before discharge?
Case managers – Discharge Planners – Social Workers
What should we remember about treating Type 1 diabetics in the hospital?
Always give steady insulin → even if NPO!!!
When you hear “Type 1 diabetic” = SOUND THE ALARMS
Always be on the lookout for DKA!
