Diabetic Care (333E2) Flashcards
difference between type 1 and type 2 diabetes
due to genetic predisposition + environmental factors, in T1 insulin producing beta cells are destroyed compared to T2 where beta cells wear out and the body becomes resistant to insulin
T1DM
-younger people
-abrupt s/s
-5-10% of all cases
-no endogenous insulin production, must have replacement insulin
3 P’s of T1DM
polyphagia (hunger), polydipsia (thirst), and polyuria
T2DM
-adults
-can go undiagnosed (often found from screenings)
-insulin resistant (treat w/ diabetic pharm and sometime insulin replacement)
non modifiable risk factors for T2DM
-fam hx
-age >45
-race/ethnicity
-hx of GDM
modifiable risk factors for T2DM
-physical inactivity
-high body fat / wt
-high BP
-high Chol
labs to check for a diabetic pt
-FBG (no food or drink in 8hr)
-casual BG (random)
-Urine ketones
-lipid profile
-OGTT
-HbA1c
FBG levels
-normal: <99
-pre diabetes: 100-125
-diabetic: 126+
casual BG - normal & emergent
<200 mg/dl ; >300 mg/dl
high urine ketones are associated with
hyperglycemia
expected finding lipid panel of a diabetic
increased LDL & TAGs, lower HDL
what do you diagnose with the OGTT
gestational diabetes -> expected results are:
-fasting <110
-1hr <180
-2hr <140
A1c levels
-normal: 4-6%
-pre diabetic: 5.7-6.4
-diabetic: >6.5%
-acceptable range for a diabetic: 6-8%, target is 7%
OGTT levels
-normal: </139
-pre diabetic: 140-199
-diabetic: 200+ (after 12hr)
what type of test do you need to diagnose T1DM
islet cell autoantibody testing
diagnostic criteria for DM
- elevated (diabetic class) of A1c, FBG, & OGTT (diet & exercise for 3 months then re eval)
-classic symptoms
Pre diabetic definition
impaired glucose tolerance, impaired fasting glucose or both (asym but long term damage can be occuring)
pre diabetic education
-teach!!
-lifestyle modification
-monitor BG & A1c
-monitor symptoms: fatigue, slow wound healing, frequently getting sick
-diet modification
oral anti diabetic meds initiation
start at low dose and then gradually increase based on A1c and FBG (oral is most frequent used for T2DM)
when is oral medications stopped for a T2DM pt
when the pt is sick and in the hospital, oral meds will stopped and pt will be put on insulin to maintain tighter glucose control until they are discharged/no longer ill
how do oral anti diabetic medications work pull from patho pharm
brown “helps reverse insulin resistance, increases insulin production, decreases hepatic glucose production, helps the body get rid of excess glucose”
important medication concepts from pathopharm
-holding metformin before procedures
-understanding what classes are used to treat diabetes (will not ask about side effects)
what to do when a patient with DM is put on steroids for illness
steroids (PO/IV) can significantly raise BG so home insulin regimen may need to change by adjusting basal dosage & increasing scheduled doses, check BG more often
why being sick with DM a big problem
-physical stress from illness may cause body to release more glucose
-pts are more prone to go into DKA (T1) or HHNS (T2)
-if stomach virus, might not be eating or drinking (still need to take med when sick if possible)
Nursing teaching points for sick DM pt
-notify HCP
-monitor BG every 2-4 hr
-continue to take meds
-prevent dehydration
-meet carb needs
-rest
nursing teaching points for when a sick DM pt needs to call HCP
-urine ketones
-BG >250
-fever >101.5 & not responding to tylenol
-feeling confused, disoriented, rapid breathing
-persistent N/V/D
-inability to tolerate liquids
-illness lasting longer than 2 days
what does frequency of blood sugar checks depend on
-glycemic goals
-type of DM
-medication regimen
-access to supplies & equipment
-pt willingness
nursing mgt of insulin
-use rapid and short acting insulin at meal times (bolus regimen)
-use a long acting insulin as a background once a day (balas regimen)
**4 injection a day: lantus or levemir at bedetime (basal), novolog or regualr before each meal (bolus)
types of rapid acting insulin & their onset, peak, duration
types: lispro (humalog), aspart (novolog), glulisine (apidra)
onset: 10-30min ~15min
peak: 30min-90min ~1hr
duration: 2-4 hr
types of short acting insulin & their onset, peak, duration
types: regular (humulin R, Novolin R)
onset: 30min-1hr
peak: 2-6hr
duration: 3-8hr
types of intermediate acting insulin & their onset, peak, duration
types: NPH (humulin N, novolin N)
onset: 2-4 hr
peak: 4-10 hr
duration: 10-20 hr
types of long acting insulin & their onset, peak, duration
types: glargine (lantus), detemir (levemir), degludec (tresiba)
onset: ~70 mins
peak: no pronounced peak
duration: 16-24 hr
insulin is a “” medication so we have to check “” and “” before giving it
high alert ; current BG level ; diet order & intake tolerance
signs & symptoms of hypoglycemia
- BG <70 (some might feel sooner if living at higher BG levels)
-sweating, blurred vision, dizziness, anxiety, hunger, irritability, shakiness, fast heartbeat, headache, weakness/fatigue
what hospital policies do you need to know before giving insulin to a pt
-what to do if your pt develops hypoglycemia (assessment, food, drug)
-if my pt is NPO, what to do with the insulin schedule
what is the most important thing we can do for our pt’s on insulin
teach (& then teach back/demo method)
main teaching points for pt giving themselves insulin
-self admin (cleaning, sites, action)
-timing is crucial (onset, peak, duration)
-monitor for signs of hypoglycemia
rule of 15 for hypoglycemia
if BG drops & pt is conscious and able to swallow then give 15g simple CHO w/ no fat (4oz juice or soda, 3 glucose tabs, 1 tbsp honey, 5 life savors), recheck BG in 15 minutes -> if still below 70 then give another 15g and if it is above 70 then have them eat a regular meal
how much should 15g of carbs increase BG
50 mg/dl
what should you do if you pt cannot swallow and becomes hypoglycemic
-IM glucagon
-IV D50 (25-50ml)
causes of hyperglycemia
illness, infection, self mgt issues, stress
treatment of hyperglycemia
-insulin
-drink fluids, prevent dehydration
-education on prevention / assess why it happened
-check for ketones in urine
DKA and HHS
BG > 500
life threatening conditions by electrolyte imbalances related to uncontrolled hyperglycemia
what does the insulin pump provide
continuous release of subQ insulin infusion (usually rapid acting) ; they can get basal infusions or bolus
how often should a diabetic person check their BG
at least 4x a day (w/ pump can use CGM)
problems to be aware of with an insulin pump
-infections at insertion site
-increased risk for DKA if pump malfunctions
-cost
-cannot swim or bathe
what are chronic complications of diabetes related to
end organ disease from chronic damage to blood vessels (angiopathy) from long term hyperglycemia
macro vascular long term DM complications
damage to large vessels:
-coronary arteries
-peripheral vascular
-cerebral vascular
microvascular long term DM complications
damage to capillaries:
-retinopathies (eyes)
-nephropathies (kidneys)
-neuropathies (sensation in extremities)
macrovascular disease x DM
-women have 4-6x risk of CVD & men 2-3x than those w/o DM
education for macrovascular disease
stop smoking, control BP, modify high fat diet, keep A1c low
what is the leading cause of end stage renal disease
diabetes
retinopathy
damage to the retina related to chronic hyperglycemia
nephropathy
damage to small blood vessels in the kidneys
neuropathy
nerve damage due to metabolic imbalances associated with hyperglycemia
nursing considerations r/t neuropathy
-highest risk is lower extremities (foot ulcers & ampts)
-loss of protective sensation (LOPS) whihc prevents pts from being aware that injury has occurred
different type of foot wounds
-neuropathic: deep ulcers
-neuroischemic: open shallow wound that doesn’t heal
-ischemic: no blood flow, leads to amputation
know the steps of diabetic foot cares
steps 1-13
nutritional considerations for diabetes
balance, high fiber, low fat (poly un is best to consume), low cholesterol, focus on carbs from whole grains, fruits, milk and legumes and then limit simply carbs (pasta, bread, sweets), lean protein/nuts/beans, limit alcohol
what can fiber do to help manage BG
improve carb metabolism and lower cholesterol
alcohol affects on a diabetic
can increase their BG but then cause rebound hypoglycemia which can be fatal
exercise x dm
-properly fitting footwear
-can lower blood sugar so if BG is <80 or >250 don’t exercise until better normalized
-best to do after meals
-eat carb snack if doing a high intensity work out >1hr post meal
-wear medical alert bracelet
nursing considerations for DM pts in the hospital
-stress/surgery can increase BG levels so can go from controlled to uncontrolled
-would healing is impaired
-high risk for infection
diabetic dermopathy
reddish - brownish spots, usually on spins
acanthosis nigricans
brown/black thickening of skin, often seen in the skin folds
necrobiosis lipoidica diabeticorum
red patches around blood vessels
