Diagnose,care,drug,nutritional,exercise Flashcards
How do you diagnose any diabetes? (4)
AIC
FASTING PLASMA GLUCOSE
OGTT( oral glucose tolerance test )
Repeat criteria 1-3 times to confirm
AIC level is __ or higher ?
What does this mean? Or reflect?
It’s used to diagnose, monitor and screen prediabetes
What is the goal?
6.5
Glucose levels over past 2-3 months
Less than 6.5 to 7%
Fasting plasma glucose is greater than?
126
2 hour plasma glucose level during OGTT greater than ?
200mg
Notes
Other test include
Lipids
Bun
Creatinine
Electrolytes
Blood pressure
Eye exam
Dental exam
Foot exam
Neurologic exam
Abi
Weight
Interprofessional care
Goals of diabetes management is?
Don’t overthink it
Decrease symptoms
Prompt well being
Prevent acute complications
Delay onset and procession of long term complications
Maintain blood glucose levels as near to normal as possible
What are we going to teach our patient? (4)
Nutritional therapy
Drug therapy
Exercise
Self monitoring of blood glucose
What drug therapy are we giving (2)
Insulin
Bigunaides ( metformin )
What does exogenous insulin mean ?
Outside source of insulin
Exogenous is required for diabetes type 1 ?
Yes! Forever
Is exogenous insulin required for type 2? Why? Or why not?
No unless the disease progresses and unable to manage glucose levels with previous therapies
When giving insulin what is the measurement?
UNITS!! Not MGS!!
Insulin is differentiated into categories, what are the 3?
Rapid acting
Intermediate acting
Slow or long acting
What is a basal Bolus regimen?
What is the goal?
Administer multiple daily injections ( or insulin pump ) with frequent self monitoring blood glucose
Achieve glucose levels as close to normal as possible as much of the time as possible
What does Bolus mean?
And before what?
Rapid
Short acting insulin before meal
What does basal mean?
How many times a day?
Intermediate
Long acting ( background )
Insulin’s once or twice a day
You want to manage postprandial glucose levels, which means?
During or relating to the period after dinner or lunch
What is rapid acting synthetic Bolus?
What are examples?
What is onset?
How long after meals?
Mimic natural insulin in response to meals
Aspart, glulisine, lispro
15mins
15mins
Short acting regular Bolus
Onset?
How long after meals?
It’s most likely to cause?
30-60mins
30-45meals
Hypoglycemia
What are used to help manage glucose levels in between meals and night ? (2)
Long acting basal
Intermediate acting insulin (NPH)
What are examples of long acting?
It is released how?
It has peaks?
Onset will what?
How many times a day?
Determir (Levemir) Glargine(Lantus)
Steadily and continuously
No
Vary
Once or twice
Intermediate acting insulin (NPH)
Duration?
Peak ?
Ensure the patient has a what to avoid hypoglycemia?
12-18 hours
4-12 hours
Bedtime snack
How is insulin normally given?
Dont over think it
NEVER GUEVN ORAL!!
Make sure to also rotate injection sites !
Subcutaneous; abdomen
What is an insulin pump?
( small battery operated device connected to a catheter inserted into subcutaneous tissue in abdominal wall )
How often do you check glucose?
Continuous subcutaneous infusion of rapid acting insulin
4-8x a day
Notes
Drug therapy
Oral and noninsulin injectable agents are in the works
To help
Insulin resistance
Decreased insulin production
Increased hepatic glucose production
What is the most effective, 1st line of treatment for type 2 diabetes?
Metformin ( Glucophage )
How does metformin work? (3)
Notes
Metformin may cause weight loss
Used to prevent type 2 diabetes
Reduce glucose production by liver
Enhances insulin sensitivity
Improved glucose transport
What are the 5 contraindications of metformin?
Renal
Liver
Cardiac disease
Lactic acidosis
Excessive alcohol intake
Metformin we want to hold for 48 hours before surgery or recieving radiologic contrast medium why?
To help prevent kidney injury
We want to take metformin with food why?
Minimize gi side effects
Notes
Nutritional therapy
Individualized plan for diabetic patients
- behavior, cognitive, cultural, religious
Registered dietitian with expertise in diabetes management
Emphasis on achieving glucose, lipids BP goals
Effectiveness of therapy monitored by blood glucose levels, AIC, lipids and BP
Moderate weight loss of to% improves insulin sensitivity
5-7
We want to do what for nutrition? (2)
Reduce saturated & trans fats
Low cholesterol
How often should exercise be for patients?
Resistance training __ a week
Notes
Benefits
- decrease insulin resistance
- weight loss
- reduce need for meds
- decrease trigs
- decrease bp
150mins a week
Moderate intensity aerobic activity
3 times a week
You want to be careful for exercising why?
During when?(2)
If you’re pre exercise blood glucose is ___< you should eat a carbohydrate snack after 15-30mins
Then delay it until normal
Hypoglycemia
Peak time at drug or didn’t eat
100
Notes
Monitoring blood glucose
Recommended for all diabetes who use insulin and others to help achieve and maintain glycemic goals
When to test
Before teals
Two hours after first bite
When hypoglycemia is suspected
Every 4 hours during illness
Before & after exercise
Notes
Nursing assessment
Subjective
- obesity, weight loss/gain, thirst, hunger, nausea, vomiting, poor healing, dietary complainance, malaise
- constipation:diarrhea frequent pee, bladder infections, Nocturia, urinary incontience
Muscle weakness fatigue
Abdominal pain
Blurred vision
Impotence
Frequent vaginal infections
Decreased libido
Objective data
Soft sunken eyeballs
Cataracts
Dry warm inelstic skin, pigmented skin lesions ulcers loss of hair in toes ( acanthodis nugricans )
Respiratory ___
Cardiovas (3)
GI__(3)
Neuro (4)
Kussmal respirations
Hypotension, weak:rapid pulse
Dry mouth, vomiting, fruit breath
Altered reflexes, restlessness, confusion, stupor, coma,
muscule wasting
You always wanna inspect the what??
FEET!!!!!!!!!!!!!!!!
