DM Flashcards
Type 1
Prevention of type 1 DM has not been successful
An individual’s risk of developing type 1 DM is estimated by:
- Considering family Hx of type 1 DM
- Attention to age of onset and sex of the affected family members
- Profiling immunity and genetic markers
Managing Type 1 DM
Optimal glycemic control is fundamental to the management of DM
Both fasting and postprandial plasma glucose levels
- correlate with the risk of complications
- contribute to the glycosylated hemoglobin value
When setting treatment goals and strategies, consideration must be given
- to individual risk factors such as age, prognosis, presence of DM complications
- comorbidities, risk for an ability to perceive hypoglycemia
Managing DM
Improved glycemic control reduces risks of microvascular complications in both type 1 and 2 DM
Improved glycemic control reduces the risk of cardiovascular disease for type 1 diabetics
Nutrition therapy
An integral part of the treatment and self-management of DM
Goals of nutritional therapy
- maintain or improve QOL and nutritional and psychological health
- prevent and treat acute and long term complications of DM, associated comorbid conditions
Nutrition Guidelines
For patients requiring weight loss:
- A weight loss of 5-15% of initial body weight can improve insulin resistance, glycemic control, BP, and lipid values
Advise on risk of hypoglycaemia resulting from alcohol consumption (carb intake, insulin dose adjustment, increase CBG monitoring)
Include at least 25g of fibre in diet (improves carb metabolism and lowers cholesterol)
Nutrition Therapy
Encourage matching insulin to carb in individuals with type 1 DM (carbohydrate counting - prescribed amount of insulin for 10 - 15 g eaten in each meal)
- 1 serving is equal to 15 carbs (serving size, carbohydrates)
- Post-prandial (post-meal) - carbs have greatest effect on blood glucose
Encourage nutritionally balanced calorie-reduced diet in overweight or obese pt (exchange list-kilocalories)
Glycemic Index
Ranking system that compares how fast carbohydrate foods raise blood glucose compared to plain glucose
- Low glycemic: raise blood glucose slowly (less processed and higher fibre)
- High glycemic: raise blood glucose quickly (refined and low fibre)
Can eat sugar containing foods but less than 10% of the total caloric intake
- Carbs 45-60%
- Protein 15-25%
- Fat 20-30% (limit trans fat, no more than 7% saturated fat)
- Cholesterol less than 200 mg/day
Low Glycemic Foods
Bread: - 100% stone ground whole wheat - Heavy mixed grain - Pumpernickel Cereal: - All Bran - Bran buds with psyllium - Oat bran Grains: - Barley - Bulgar - Pasta, noodles (WW) - Parboiled or converted rice Other: - Sweet potatoes - Yams - Legumes (lentils, chick peas, kidney beans, split peas, baked beans, soy beans)
Meals
Children (5-12) taught to have a consistent meal plan
Teens and preteens more flexibility focuses on insulin to carbohydrate ratio
Carbohydrates content based on 15 gm
- 1 slice of bread, 1 medium apple, 1/2 cup of choco milk, 3 cups popcorn
- Breakfast 30 gm
- Morning snack 15 gm
- Lunch 60 gm
- Afternoon snack 15 gm
- Supper 35 gm
- Evening snack 20 gm
Insulin
Goal of insulin treatment - mimic pancreas; small amounts of insulin at a time
Extra insulin given with food or in response to high blood glucose
Adjust their insulin based on carbohydrate content of their meals
Dietary fibre should be subtracted from total carbohydrates
Recommendations
150 min/week mod-vigorous exercise As well as resistance 2x week Exercise safely - community pools, gyms, safe walking, etc. - Medic Alert ID Pre-exercise assessment prior to program - Neuropathy, retinopathy, CAD, PVD Tools can be found on CDA Use proper footwear Inspect feet daily and after exercise Avoid exercise in extreme hot or cold - and during periods of poor glucose control Over 35: ECG stress test
Precautions
If pre-exercise glucose levels are less than 5.5 mmol/L, approximately 15-30 gm of carbs should be ingested before exercise
Avoid exercise is CBG is >16.7 mmol/L and the patient does not feel well, and ketones present
Individuals with type 2 DM generally do not need to postpone exercise because of high blood glucose, provided they feel well, if CBG are elevated to >16.7 mmol/L, it is important to ensure proper hydration and monitor for S&S (increased thirst, nausea, extreme fatigue, blurred vision, or headache), especially for exercise to be performed in the heat
Nursing Considerations: Exercise
Reinforce:
- Improved strength and endurance
- Improved cardiovascular funciton
- Decreased risk for CAD (lowers cholesterol and triglycerides and improves HDLs)
- Reduced weight and body fat
- Improved well being and QOL
Insulin
Infants, toddlers, and preschoolers
- Start with 2 injections a day, mixture rapid, intermediate or long acting insulin before breakfast and supper
Children (5/6)
- Start 3 injections/day, mixture rapid and intermediate before breakfast, rapid acting before supper, and intermediate before bed time
Insulin
Teenagers
- Move to or start with multiple injections
- Rapid acting before meals and major snacks, intermediate or long acting before bedtime
- More injections: not a sign of worsening DM
- Consistency of ratio with insulin and carbohydrates
- Allows flexibility when eating but keeps sugars within target
Insulin Requirements: Affected by
Growth and development Appetite Physical activity Stress or illness No fixed dose will work indefinitely
