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Med surg > DM2 > Flashcards

DM2 Flashcards

1
Q

DM nutrition mgmt plan

A
  • eat from all food groups
  • plan to eat meals nor more than 4-5 hrs apart
  • type 1: increase calorie intake
  • type 2: decrease calorie intake
  • reduction of 500cal/day = weight loss of 1lb/week
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2
Q

DM1 nutritional tx

A
  • meal plan is based on individual’s usualy -food intake and is balanced with insulin and exercise patterns
  • insulin regiment is managed day to day
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3
Q

DM2 nutritional tx

A
  • emphasis is based on achieving glucose, lipid, and blood pressure goals
  • calorie reduction
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4
Q

carbs in nutritional tx

A
  • 130g/day
  • fiber 14g/1000kcal
  • sugar alcohols and nonnutritive sweeteners are safe when consumed with FDA daily intake levels
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5
Q

glycemic diet

A

-the rise in BG levels after CHO containing food is consumed

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6
Q

fats in nutritional tx

A
  • less than 200mg/day of dietary cholesterol
  • trans fats should be minimized
  • limit <7% from saturated fats
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7
Q

protein in nutritional tx

A
  • suggested protein intake is 15-20%

- high protein diet no recommended as a weight loss method for diabetics (except for kids bc they need to grow)

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8
Q

alcohol in nutritional tx

A
  • high in calories
  • no nutritive value
  • promotes hypertriglyceridemia
  • detrimental effects on liver
  • can cause severe hypoglycemia
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9
Q

diet teaching

A
  • counting carbs
  • USDA MyPyramid guide
  • Plate method: 1200-1400 cals/day
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10
Q

3 important things to teach with meal planning

A
  • consistent eating habits
  • relationship between food and insulin
  • providing an individualized meal plan
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11
Q

ways foods are organized into groups

A
  • # of calories
  • composition
  • effects on blood glucose
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12
Q

therapeutic effect of regular exercise

A

a decreased need for diabetes medicines in order to reach target BG goals

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13
Q

role of exercise in DM

A
  • improves uptake of glucose by the muscles
  • reduces cardiovascular risk
  • improves circulation and muscle tone
  • lowers lipid blood concentration
  • increased HDL
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14
Q

exogenous insulin

A
  • injected insulin
  • required for DM1
  • prescribed for DM2 who cannot control BG by other means
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15
Q

basal bolus regimen

A
  • closely mimic endogenous insulin

- includes a long acting (basal) once a day and a rapid/short acting (bolus) before meals

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16
Q

goal of basal bolus regimen

A

achieve a near-normal glucose level of 80-120mg/dL before meals

17
Q

insulin storage

A
  • store in a cool place
  • do not heat/freeze
  • in use vials may be left at room temp up to 4 weeks
  • extra insulin should be refridgerated
  • avoid exposure to direct sunlight
18
Q

nursing interventions for insulin

A
  • cannot be PO
  • regular is the only that can be IV
  • subQ for self injection
  • fastest absorption: abd, then arm/thigh, then butt
  • rotate injections with one particular site
  • do not inject site to be exercise
19
Q

insulin pumps

A
  • continuous subQ insulin infusion
  • insulin can be rapid or short acting
  • insertion site changed q2-3 days
  • requires frequent finger sticks q4h
20
Q

problems with insulin tx

A
  • hypoglycemia
  • allergic reaction
  • lipodystrophy
  • somogyi effect
  • dawn phenomenon
21
Q

somogyi effect

A
  • rebound effect in which an overdose of insulin causes hypoglycemia
  • counterregulatory hormones release
22
Q

dawn phenomenon

A

characterized by hyperglycemia present on awakening in the morning
d/t release of counterregulatory hormones in predawn hours

23
Q

oral agents

A
  • works to improve mechanisms by which insulin and glucose are produced and used in the body
  • works on these 3 defects of DM2: insulin resistance, decreased insulin production, & increased hepatic glucose production
  • *sulfonylureas, meglitinides, biguanides, a-glucose inhibitors, thiazolidinediones
24
Q

incretin mimetic

A
  • synthetic peptide
  • stimulates release of insulin from beta cells
  • subQ injections in a prefilled pen
  • suppresses glucagon secretion
  • reduces food intake
  • slows gastric emptying
  • not to be used with insulin
25
Q

b-adrenergic blockers

A
  • masks symptoms of hypoglycemia

- prolong hypoglycemic effects of insulin

26
Q

thiazide/loop diuretics

A

can potentiate hyperglycemia by inducing K loss

27
Q

DM1 in pediatrics

A
  • 4-5 yrs: can help with injection
  • 6-7 yrs: can tell you if foods have sugar
  • 8-10 yrs: can give own injection and testing with supervision
  • 11-13 yrs: can measure own insulin
  • 14+ : can do mixture of insulin
28
Q

geriatric considerations

A

-prevalence of DM increase with age
-undiagnosed & untreated DM more common
-hypoglycemic awareness needed
-delayed psychomotor function
-decline in cognitive function
0functional limitations: visual acuity, manual dexterity

29
Q

pancreas transplant

A
  • used for DM1 who also have ESRD or plan to have/had a kidney transplant
  • usually kidney & pancreas transplants are done together
  • eliminates the need for exogenous insulin
  • can also eliminate hypoglycemia & hyperglycemia
30
Q

immediate tx needed on sick day

A
  • persistent emesis and unable to keep down any fluids
  • persistent diarrhea with weakness
  • labored or difficulty breathing
  • positive urine ketones after 12-24hr of tx
  • changes in mental status
31
Q

pancreatic islet cell transplant

A
  • islets are harvested from the pancreas of a deceased organ donor
  • pain & recovery time are diminished
32
Q

overall goals in mgmt of DM

A
  • active pt participation
  • few or no episodes of acute hyperglycemic emergencies or hypoglycemia
  • maintain normal blood glucose levels
  • prevent or delay chronic complications
  • lifestyle adjustments with minimal stress
33
Q

sick day pt guideline

A
  • continue meals, may need insulin more than the usual
  • glucose check q3-4h
  • maintain hydration
  • need at least 150gms of CHO
  • evaluate OTC meds
34
Q

health promotion of DM

A
  • identify those at risk

- provide routine screening for overweight adults over age 45

34
Q

reasons to call the MD on sick day

A
  • vomiting more than once
  • diarrhea 5x+ or 24hr+
  • difficulty breathing
  • BG>300mg/dL on 2 consecutive readings
  • +ketones in urine
  • changes in mental status

Med surg (11 decks)

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