DM2 Flashcards
DM nutrition mgmt plan
- 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
DM1 nutritional tx
- 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
DM2 nutritional tx
- emphasis is based on achieving glucose, lipid, and blood pressure goals
- calorie reduction
carbs in nutritional tx
- 130g/day
- fiber 14g/1000kcal
- sugar alcohols and nonnutritive sweeteners are safe when consumed with FDA daily intake levels
glycemic diet
-the rise in BG levels after CHO containing food is consumed
fats in nutritional tx
- less than 200mg/day of dietary cholesterol
- trans fats should be minimized
- limit <7% from saturated fats
protein in nutritional tx
- 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)
alcohol in nutritional tx
- high in calories
- no nutritive value
- promotes hypertriglyceridemia
- detrimental effects on liver
- can cause severe hypoglycemia
diet teaching
- counting carbs
- USDA MyPyramid guide
- Plate method: 1200-1400 cals/day
3 important things to teach with meal planning
- consistent eating habits
- relationship between food and insulin
- providing an individualized meal plan
ways foods are organized into groups
- # of calories
- composition
- effects on blood glucose
therapeutic effect of regular exercise
a decreased need for diabetes medicines in order to reach target BG goals
role of exercise in DM
- improves uptake of glucose by the muscles
- reduces cardiovascular risk
- improves circulation and muscle tone
- lowers lipid blood concentration
- increased HDL
exogenous insulin
- injected insulin
- required for DM1
- prescribed for DM2 who cannot control BG by other means
basal bolus regimen
- closely mimic endogenous insulin
- includes a long acting (basal) once a day and a rapid/short acting (bolus) before meals
goal of basal bolus regimen
achieve a near-normal glucose level of 80-120mg/dL before meals
insulin storage
- 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
nursing interventions for insulin
- 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
insulin pumps
- continuous subQ insulin infusion
- insulin can be rapid or short acting
- insertion site changed q2-3 days
- requires frequent finger sticks q4h
problems with insulin tx
- hypoglycemia
- allergic reaction
- lipodystrophy
- somogyi effect
- dawn phenomenon
somogyi effect
- rebound effect in which an overdose of insulin causes hypoglycemia
- counterregulatory hormones release
dawn phenomenon
characterized by hyperglycemia present on awakening in the morning
d/t release of counterregulatory hormones in predawn hours
oral agents
- 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
incretin mimetic
- 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
b-adrenergic blockers
- masks symptoms of hypoglycemia
- prolong hypoglycemic effects of insulin
thiazide/loop diuretics
can potentiate hyperglycemia by inducing K loss
DM1 in pediatrics
- 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
geriatric considerations
-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
pancreas transplant
- 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
immediate tx needed on sick day
- 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
pancreatic islet cell transplant
- islets are harvested from the pancreas of a deceased organ donor
- pain & recovery time are diminished
overall goals in mgmt of DM
- 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
sick day pt guideline
- continue meals, may need insulin more than the usual
- glucose check q3-4h
- maintain hydration
- need at least 150gms of CHO
- evaluate OTC meds
health promotion of DM
- identify those at risk
- provide routine screening for overweight adults over age 45
reasons to call the MD on sick day
- vomiting more than once
- diarrhea 5x+ or 24hr+
- difficulty breathing
- BG>300mg/dL on 2 consecutive readings
- +ketones in urine
- changes in mental status
