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