[Exam 3] Chapter 51: Assessment and Management of Patients with Diabetes ( Page 1456 - 1483, 1496-1500 ) Flashcards
What is diabetes?
A group of diseases characterized by hyperglycemia (high blood sugar) caused by defects in insulin secretion, insulin action, or both.
What does diabetes alter?
Alters CHO, Protein, and Fat Metabolism.
Increases risk of CVD.
What is Type 1 Diabetes?
Considered autoimmune disease, occuring after a virus. Insulin-producing beta cells in the pancreas are destroyed by an autoimmune process
Why does Type 1 Diabetes require insulin?
Because little or no insulin is produced. Onset is acute and usually before 30.
Type 1 Diabetes accounts for how much of the population?
5-10%, with it being genetic.
What does Insulin do?
Insulin secretion increases and moves glucose from the blodo into muscle, liver, and fat cells
What happens to Insulin in Type 2 Diabetes?
Islets of Langerhans in the Pancreas stops producing insulin
General description of Type 2 Diabetes?
Produce insulin, but have decreased sensitivity to insulin (insulin resistance) and impaired beta cell function result in decreased insulin production
Population % that has Type 2 Diabetes?
90-95% of people with diabetes, onset over age of 30, increasing in children, obesity,
Type 2 Diabetes is a slow, progressive what?
glucose intolerance
Type 2 Treated initially with
diet and exercise
Why would Oral Hypoglycemic agents be used with Type 2 Diabetes?
Initially may need to convert insulin or use both
Number one cause of Type 2 Diabetes?
Obesity
Type 1 Diabetes: What is the range of glucose in the blood that should not exceed?
180-200 mg/dL
What type of Diabetes is referred to as Pre Diabetic?
Type 2
What does Type 1 require for treatment?
Insulin Injection, and is a lifelong condition.
Type 2 Diabetes and Islets of Langerhans in Pancreas produce how much Insulin?
Still produce, but in a lesseer amount
Treatment for Type 2 Diabetes?
Exercise and Diet
Oral Hypoglycemic
Insulin if nothing else works
Type 2: Insulin resistance may lead to what symptoms?
Hypertension, hypercholesterolemia, abdominal obesity, and other abnormities
Functions of Insulin (6)
Transports and metabolizes glucose for energy
Stimulates storage of glucose in liver and muscle as glycogen
Signals the liver to stop release of glucose
Enhances storage of fat in adipose tissue
Accelerates transport of amino acids into cells
Inhibits the breakdown of stored glucose, protein, and fat
Unhooking your insulin pump means what for fat?
Cannot store fat, meaning you will be skinny
What are the risk factors for getting Type 1 Diabetes?
Early Onset, Familial, Genetic Predisposition, Possible immunologic or environmental (viral or toxins) factors
What are the risk factors for getting Type 2 Diabetes?
Obesity, age, previous identified impaired fasting glucose or impaired glucose tolerance.
Hypertension > 140/90 , HDL < 35, Triglycerides >250
History of Gestational Diabetes or babies over 9 lbs
Diabetes Signs and Symptoms: What are the “Three Ps”?
Polyuria (Urinate A lot), Polydipsia (Increase in thirst due to high suger in body, increasing osmolality in blood), Polyphagia (excessive hunger or increased appetite)
Diabetes Signs and Symptoms: What are signs and symptoms seen here?
Fatigue, weakness, vision changes, tingling, or numbness in hands or feet, dry feet, skin lesions or wounds slow to heal, recurrent infections
Diabetes Signs and Symptoms: Why is there an increased risk of slow wound healing and recurrent infections?
- Increased RF Atherosclerosis because cannot metabolize fat and decreases blood flow to peripheries.
- Bacteria doesn’t die because it has good nutrient source
- Low protein = low wound healing.
- Wound site releases signal to WBC. Chemical not released here, and not concentrated at the wound bed to heal
Diabetes Signs and Symptoms: Specific signs for Type 1 Diabetes
Sudden weight loss, N/V, Abdominal Pain if DKA developed
Type 1: What is Diabeetic Ketoacidosis?
Since theres no insulin to carry food , and to carry the glucose across the membrane. It starts to breakdown muscle and fat as a means of energy,, resulting in ketone bodies being formed causing patient to become acidotic.
Diabetes: Fasting blood glucose is what?
126 mg/dL or more
Diabetes: Random glucose exceeding what?
200 mg/dL
Diabetes: A1-C (gluco-sided hemoglobin, blood test done every 3-4 months) greater than 7% tells what?
How well glucose was controlled over last 3-4 months
Diabetes: Urine glucose and ketone levels (don’t want to see high amount of ketone)- monitor for
DKA
Diabetes: Uriene tests monitor what?
Kidney Function
Diabetes: Serum Cholesterol monitored due to
the effect on lipid metabolism can cause hyperlipidemia increasing cardiovascular risks
Diabetes: Serum electrolytes monitored because
serum osmolality in the blood can be changed
Diabees Mellitus - Assessment: One of the major roles of nurses in diabetic management is
education of the diabetic patient
Diabees Mellitus - Assessment: Nursing care and educational plans for the diabetic patient need to be individualized based on…
Type of Diabetes
Length since diagnosis and prior knowledge
Patients individual health and socioeconomic circumstances
Are they able to recognize hyper and hypoglycemia
DO they have symptoms of complications
Type 1 Diabetes: What is the Dawn Phenomenon?
Wake up with high blood sugars without a preceding low. Not enough insulin on board to tell liver to not release glucose.
Type 1 Diabetes: What is the Somogyi Effect?
Blood sugar drops low in night due to too much bedtime insulin or to small of bedtime snack and the body responds with an increase in glucose release cauing high morning blood sugar
Type 1 Diabetes: Dawn Phenomenon is treated how?
With Insulin
Type 1 Diabetes: How is Somogyi Effect treated?
Giving them a bedtime snack so they don’t have that low.
Type 1 Diabetes: How to determine whether individual has Dawn Phenomenon or Somogyi Effect?
Have them set an alarm in the middle of the night to check their glucose. If low at 1am, it means its Somogyi.
Diagnosis of patients with Diabetes
Imbalanced Nutrition (Cannot carry glucose across cell and metabolize it)
Risk of Impaired Skin Integrity (Wounds don’t heal/ increased blood osmolality)
Deficient Knowledge (Don’t know how to care for it/ A1-C)
Risk for Infection (WBC cannot concentrate)
Risk for Injury
Sexual Dysfunction
Main treatment goal of those with diabetes?
Maintain normal blood glucose levels (Hgb A1C <7%)
Diabetes Treatment Goal: What is Intensive Control?
3-4 Insulin injections per day, or continuous subcutaneous insulin infusion via insulin pump therapy plus frequent blood glucose monitoring, weeakly contacts with diabetic educations,
Diabetes Treatment Goal: Intensive Control causes there to be a decreased development and progression of complications such as
retinopathy (damage to small blood vessels that nourish the retina), nephropathy (damage to kidney cells) and neuropathy (damage to nerve cells)
Diabetes Treatment Goal: What do you want to prevent?
Complications, hypo and hyperglycemic episodes
Major Goals for Diabetes include
improved nutritional status, maintenance of skin integrity (foot care because furthest from heart and with neuropathy because they don’t notice wounds. ), ability to perform basic diabetes self-care skills, as well as preventive care for the avoidance of chronic complications of diabetes
Planning the Care of the patient with diabetes: What should the patient focus on doing?
Good glucose control
Weight management
Skin Care
Foot Care
Preventing Complications (lowering lipids, taking an statin every day)
Planning the Care of the patient with diabetes: What is a useful way to check their feet in the morning?
Place a mirror under the bed to check underneath
Planning the Care of the patient with diabetes: If buying new shoes, when should they buy them?
Late in teh day, because the shoes are already swollen
What are all the difference categories that can be used to treat blood glucose?
Nutrition Therapy
Exercise
Monitoring (Check blood glucose, check eyes, if ketones are present)
Pharmacologic Therapy
Education
Self Monitoring of Blood Glucose: Test blood when?
AC and HS
AC = Before meals and HS = At bedtime,
Meaning four checks will occur and record the results
Self Monitoring of Blood Glucose: Analyzing the Results includes what?
Am i running high in the morning?
Am i running low before bed?
Self Monitoring of Blood Glucose: If blood glucose looks good before bed but running a high A1c, physicians can order
P. Blood Sugars which will take blood sugar 2 hours after they eat to see if they have enough insulin to cover teh carbohydrates that they eat
Self Monitoring of Blood Glucose: WHat is the target glucose level that should be monitored?
80-120
Self Monitoring of Blood Glucose: Physician should be called when?
When readings are out of range
Self Monitoring of Blood Glucose: When would Urine Testing for DKA happen?
When blood sugar is over 240 do a ketone stick to see if ketones or glucose is in the urine.
Self Monitoring of Blood Glucose: Urine testing and ketones with blood sugar greater than 240 means what?
Patient does not have enough insulin in their body
Nutritional Goals: what is the first thing that should be focused on here?
Maintain the pleasure of eating, include personal and cultural preferences
NutritionalGoals: Promotion of what should occur?
Exercise and Activity
NutritionalGoals: Achieve and maintain a BMI of
<25
NutritionalGoals: Should try to prevent and decrease what?
Wide fluctuations of blood glucose levels and decrease serum lipids if elevated
NutritionalGoals: How many calories should be had?
1800 calorie American Diabetes Association diet (Right carbohydrate, protein, fat ratio, and avoiding concentrated sweets)
NutritionalGoals: Glycemic Index should be taught because it teaches
how quickly a food increases the glucose level after you’ve eaten it. Want to eat low glycemic foods (those without refined sugars) because blood sugar does not spike
NutritionalGoals: What decreases the rise of glucose?
Fiber and protein decrease the rise of blodo sugars
Nutritional Goals & Meal Planning: Understand that their diet needs to have what?
High fiber, low fat, and no concentrated sweets
Nutritional Goals & Meal Planning: Can they have alcohol?
Make sure they consume light beer to help with lipid levels and stay away from sweetened drinks
Nutritional Goals & Meal Planning: Is it okay to have artifical sweeteners
Beware that some are very hard on the kidney and can have some side effects
Nutritional Goals & Meal Planning: Sugar free products can cause what side effects
Diarrhea , and increased gas production
Nutritional Goals & Meal Planning: Diabetic population is taught to do what in order to determine how much insulin to give?
Count carbohydrates eaten in a meal.
Nutritional Goals & Glycemic Index: What slows absoprtion and glycemic response?
Combining starchy foods with protein and fat
Nutritional Goals & Glycemic Index: What tends to have a lower response than cooked, chopped, or pureed foods?
Raw or whole foods
Nutritional Goals & Glycemic Index: Eat whole foods rather than juices because it does what?
Decreases glycemic response because of fiber (slowing absorption)
Nutritional Goals & Glycemic Index: Adding foods with sugar may produce what response?
Lower response if eaten with foods that are more slowly absobred
Nutritional Goals & Glycemic Index: What slows the absorption of glucose the most?
Fiber
Benefits of Exercise and Diabetes?
Lowers Blood Sugar (By using glucose)
Aids in weight loss (helps those who are type 2)
Lowers cardiovascular risk
Reduces insulin resistance (Cell membranes are resistant to insulin, but exercise makes it easier for insulin to carry glucose across the cell membrane)
Exercise Precautions: Do not exercise when?
Blood sugars elevated above 250 mg/dL and ketones present in urine
If ketones present, it means that body is already broken down fat and protein to accomdate for energy needs
Exercise Precautions: If exercising to control or reduce weight, what must be done?
Insulin must be adjusted
Exercise Precautions: Insulin normally decreases with exercise, meaning patietns on a exogenous insulin should eat how many carbs and when?
15 g carb snack before moderate exercise to prevent hypoglycemia
Exercise Precautions: There is a risk for potential postexercise
hypoglycemia . They’ve burned off all of their glucose.
Exercise Precautions: Need to continue to monitor…
blood glucose levels
Insulin Therapy: Categories of Insulin?
Rapid Acting (3 mins)
Short Acting (5-10 mins)
Intermediate Acting
Very Long Acting
Insulin Therapy: Insulin pumps only use what type of insulin?
Rapid Acting
Insulin Therapy: Sliding scales means that
physician will look at their glucose level and then that will determine how much they will recieve.
Insulin Therapy: Make sure you store insulin in a location that does not ave
a lot of heat, because its protein based and will break down insulin
Insulin Therapy: Insulin stored long term should be kept where
Refridgerator
Insulin Therapy: Mixing insulin, clear to cloudy meaning what is pulled first?
Fast accting first and then intermediate acting.
Insulin Therapy: If at a restaurant, when should they give their insulin?
Giv rapid acting right when the food appears in front of them
Insulin Therapy: Make sure rotating sites because
to prevent the buildup of scar tissue which decreases absorption.
Rapid Acting Drugs?
Lispro, Aspart (NovoLog) and Glulisine (Apidra)
Rapid Acting, Lispro: Onset?
0.25 hours
Rapid Acting, Lispro:Peak?
1-1.5 hours
Rapid Acting, Lispro: Duration?
3-4 hours
Rapid Acting, Aspart (NovoLog): Onset?
0.25 hours
Rapid Acting, Aspart (NovoLog): Peak?
40-50 minutes
Rapid Acting, Aspart (NovoLog): Duration?
3-5 hours
Rapid Acting, Glulisine (Apidra): Onset?
0.25 hours
Rapid Acting, Glulisine (Apidra): Peak?
1-1.5 hours
Rapid Acting, Glulisine (Apidra): Duration?
3-5 hours
Short Acting Drugs?
Regular (Novolin-R, Humulin-R)
Short Acting, Regular (Novolin-R, Humulin-R): Onset
0.5-1 hour
Short Acting, Regular (Novolin-R, Humulin-R): Peak?
2-3 hours
Short Acting, Regular (Novolin-R, Humulin-R): Duration?
4-6 hours
Intermediate Acting Drugs?
NPH (Humulin (N) NPH), Detemir (Levemir)
Intermediate Acting, NPH (Humulin (N) NPH): Onset?
2 Hours
Intermediate Acting, NPH (Humulin (N) NPH): Peak?
6-8 hours
Intermediate Acting, NPH (Humulin (N) NPH): Duration?
12-16 hours
Intermediate Acting, Detemir (Levemir): Onset?
Not defined
Intermediate Acting, Detemir (Levemir): Peak?
Not defined
Intermediate Acting, Detemir (Levemir): Duration?
17-24 hours
Long Acting Drugs?
Glargine (Lantus)
Long Acting, Glargine (Lantus): Onset?
Not dfined
Long Acting, Glargine (Lantus): Peak?
Not defined
Duration?
24 hours
Combination Drugs
Humulin 50/50
Humulin 70/30
Novolin 70/30
Combination, Humulin 50/50: Onset?
0.5 hours
Combination, Humulin 50/50: Peak?
3 hours
Combination, Humulin 50/50: Duration?
22-24 hours
Combination, Humulin 70/30: Onset?
0.5 hours
Combination, Humulin 70/30: Peak?
4-8 hours
Combination, Humulin 70/30: Duration?
24 hours
Combination, Novolin 70/30: Onset?
0.5 hours
Combination, Novolin 70/30: Peak?
4-8 hours
Combination, Novolin 70/30: Duration?
24 hours
When is Oral Antidiaetic Agents used??
For patients with type 2 diabetes who require more than diet and exercise alone.
some stimulate pancrease to produce more insulin, cause liver to release les glucose, or make it easier to move glucose.
Oral Antidiabetic Agents: Combination of what may be used?
Oral drugs
Oral Antidiabetic Agents: Major side effect?
Hypoglycemia
Oral Antidiabetic Agents: Nursing intervention?
Monitor blood glucose for hypoglycemia and other potential side effects
Oral Antidiabetic Agents: Need to follow what sort of plan?
Weight loss plan
Sick Day Management: What is required here in terms of insulin?
Increased need for insulin or at minimum continue same regimen even if food intake is less
Sick Day Management: Hyperglycemia can occur from
stress or illness
Sick Day Management: Call the doctor if
ketones present, unable to eat for 24 hours, or vomiting or diarrhea for 6 hours
Acute Complications of Hyperglycemia Diabetes?
DKA and HHS (When no ketones present, but hyperosmolality present)
Chronic Complications of Hyperglycemia Diabetes?
Neuropathy (Neurological damage, pain in feet and hands or numbness here.)
Vascular in a macro or micro sense. (Peripheral damage or kidney damage or blindness)
Result of endothelial inflammation and thickening
Hypoglycemia: What is htis?
Abnormally low blood glucose levels (below 50-60). Means too much insulin or oral hypoglycemic agents, excessive physical activity, or not enough food
Hypoglycemia: Adrenergic Symptoms?
Sweating, tremors, tachycardia, palpitations, nervousness, hunger
Hypoglycemia: Central Nervous System Symptoms?
Inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness, change in personality
Hypoglycemia: Severe Hypoglycemia signs are
Disorientation, Seizures, Loss of Consciousness, Death
Hypoglycemia & Assessment: Onset occurs how quickly?
Abrupt and may be unexpected
Hypoglycemia & Assessment: Symptoms in people?
Vary from person to person
Hypoglycemia & Assessment: Symptoms may be related to what?
Rapid decrease in blodo glucose and usual blood glucose range
Hypoglycemia & Assessment: Decreased adrenergic response may affect symptoms in persons who have had
diabetes for many years probably related to autonomic neuropathy
Hypoglycemia and Treatment: What should be done first?
Give 15 g of fast-acting, concentrated cabohydrate.
Hypoglycemia and Treatment: Examples of fast-acting, concentrated carbohydrates include…
3-4 glucose tablets
4-6 oz of juice or regular soda
6-10 candies(skittles)
2-3 tsp of honey
Hypoglycemia and Treatment: Retest blood glucose after how long of a wait?
15 minutes , and retreat if <70 or if symptoms persistent more than 10-15 mins and testing not possible
Hypoglycemia and Treatment: Provide a snack with protein and cabohydrate unlesss patient plans to
eat a meal within 30-60 minutes
Hypoglycemia and Emergency Measures: If patient cannot swallow or is unconscious.. what is given?
Subcutaneous or intramuscular glucagon (1mg) , should be carried as emergency medication
25-50 mL of 50% dextrose solution IV; very viscious and hard to push, used in hospitals.
Cake icing placed on cheek can be absorbed and raise the blood sugar.
Long-Term Complcations of Diabetes: Macrovascular Effects?
Accelerated Atherosclerotic Changes, Coronary Artery Disease, Cerebrovascular Disease and Peripheral Vascular Disease
Long-Term Complcations of Diabetes: Microvascular Effects?
Diabetic Retinopathy and Nephropathy
Long-Term Complcations of Diabetes: Neuropathic Effects?
Peripheral Neuropathy, Autonomic Neuropathies, Hypoglycemic Unawareness, Neuropathy, Sexual Dysfunction
What is Self-Monitoring of Blood Glucose?
A method of capillary blood glucose testing in which the patient pricks their finger and applies a drop of blood to a test strip that is read by a meter
Insulin Pens: How much do these hold?
150-300 units
Insulin Pens: These are most useful for which type of patient?
Patients who need to inject only one type of insulin at a time. Those who also administer right before eating
Insulin Pens: What are Jet Injectors?
Delivers insulin through the skin under pressure in an extremly fine stream
Insulin Pumps: Patient inserts needle where?
Needle or catheter into subcutaneous tissue and secures it with tape or transparent dressing
Insulin Pumps: Insulin delievered at a basal rate of what?
0.025 - 2 units per hour
Insulin Pumps: When patient eats a meal, they calculate what?
They count the number of carbohydrates for the meal using a predetermined insulin -to - carbohydrate ratio
Insulin Pumps: You use 1 unit of insulin for how much carbohydrates?
15 grams
Selecting Syringes: 1 mL syringe holds how much?
100 unit capacity
Selecting Syringes: 0.5 mL syringe holds how much insulin?
50 unit capacity
Selecting Syringes: 0.3 mL syringe holds how much insulin?
30 unit
Mixing Insulins: Special thing to do with long actinb insulin?
It must be mixed throughly before drawing into the syringe
Injecting Insulins: Speed of insulin is absorbed fastest in what site?
Greatest in abdomen
Type 1: General description of this?
Acute onset, occurs in patients genetically susceptible to type 1 diabetes , a triggering event such as a viral infection.
Type 1: A viral infection causes production of autoantibodies which does what?
Kills the beta cells in the pancreas. Leading to decline in and ultimate lack of insulin secretion
Type 1: What is Insulin Deficiency, and leads to what?
When more than 90% of the beta cells have been destroyed and lead to hyperglycemia, enhanced lipolysis, and protein catabolism
Type 2: General description of this?
Slow progressive onset, chronic disease caused by one or more factors
Type 2: What factors can cause this?
Impaired insulin production, inappropriate hepatic glucose production, or peripheral insulin receptor insensitivity
Complications of Diabetes come from ?
Endothelial inflammation caused by increase in glucose levels and result in thickening of the enothelial lining of vascular and neuropathic structures
Both Type 1 and 2 alters what?
CHO, Protein, and Fat Metabolism
Functions of Insulin?
Transport and metabolize glucose for energy
Stimulates sotrage of glucose in the liver and muscles as glycogen
Singals liver to stop release of glucose
Enhances storage of fat in adipose tissue
Accelerates transport of amino acids into cells
Inhibits breakdown of stored glucose, protein, and fat
Prevention of Diabetes?
Maintain healthy weight
Exercise
MAintain tight glucose control to prevent complications
ASA to prevent cardiovascular risks
Type 1 Risk Factors?
Genetic disposition
Viral Infection
Type 2 Risk Factors?
Obesity, Age, Hypertension, Hyperlipidemia, Gestational Diabetes
Diabetes Labs and Diagnostics: Fasting glucose would be
126 or more
Diabetes Labs and Diagnostics: Random glucose would be
> 200
Diabetes Labs and Diagnostics: What would A1C levels be?
> 7% in last 3-4 months of glucose levels
Diabetes Labs and Diagnostics: Why is urine glucose and ketone levels monitored?
To monitor for DKA
Diabetes Labs and Diagnostics: Why are Urine tests conducted?
Monitor kidney function
Diabetes Labs and Diagnostics: Why is serum cholesterol evaluated?
to determine Decreases of lipid metabolism, and risk of cardiovascular disease
Complications of Diabetes?
Cardiovascular Disease
Nephropathhy
Retinopathy
Neuropathy
Ketoacidosis and Hyperosmolar Coma
Infections
Hypoglycemic Coma
Hypoglycemia: Range for this?
Below 50-60 mg/dL
Hypoglycemia: How does the onset appear?
Abrupt and can e unexpected
Hypoglycemia: Causes iof this?
Too much insulin
Not Enough Food
Excessive physical exercise of stress
Hypoglycemia: Signs and Symptoms?
Sweating and Cool To Touch
Tremors
Tachycardia and Palpatations
Nervousness and Inability to Concentrate
Hunger
headache and Confsusion
Slurred Speech
Drowsiness
Hypoglycemia: Severe hypoglycemia signs and symptoms?
Seizures, loss of consciousness, death
Hypoglycemia: What would you do to treat this?
Give 15 g of fast acting, concentrated carbohydrate
Hypoglycemia: What does 15 g of fast acting, concentrated carbohydrate look like?
3-4 glucose tabs, 6-10 skittle candies, and 2-3 tsp honey
Hypoglycemia: What to do after patient given the 15 g of carbohydrates?
Retest BG in 15 minutes, and retreat if less than 70 or if symptoms persist for more than 10-15 minutes after txx.
Hypoglycemia: Once glucose is WINL, give what?
Give protein snack unless patient is eating a meal within 30-60 minutes
Hypoglycemia: What to do if patient is unconscious or cannot swallow?
Sq or IM Glucagon (1mg) or 25-50 mL of 50% dextrose IV
Diabetes Assessment: What should we figure out from patient?
What type of diabetes
When diagnosed and knowledge of care
Socioeconomic status
General health
Diabetes Assessment: What should patient recognize as hyperglycemia?
hot and dry sugar hgih
Diabetes Assessment: What should patient recognize as hypoglycemia?
Cold and clammy needs some candy
Diabetes Assessment: Three P’s of Diabetes?
Polyuria, Polydipsia, and Polyphagia
Diabetes Assessment: Signs and Symptoms od Diabetes?
Fatigue and Weakness, Vision Changes, Tingling/Numbness/Burning in feet and hands, Dry Skin and Wounds that won’t heal
Diabetes Assessment: Signs specific to Type 1 Diabetes?
Sudden weight loss, N/V, Abdominal pain/fruity breath with DKA
Diabetes Diagnoses: What would these be?
Impaired nutrition
RF Impaired Skin Integrity
Deficient Knowledge
RF Infection
RF Injury
Sexual Dysfunction
Goals and Planning for Diabetes?
Tight control of blood glucose levels
BMI below 25
Foot and Skin Care
Frequent blood glucose monitoring (fasting, AC, HS)
Diabetes Interventions: What does treatment include?
Nutrition Therapy - 1800 cal ADA
Exercise
Frequent BG Monitoring
Pharmocologic Therapy
Education
Diabetes Interventions: What two specific things do you lok for?
Dawn Phenomenon
Somogyi Effect
Diabetes Interventions: What is the Dawn Phenomenon?
Wake up with high BG without a preceding low
Diabetes Interventions: What is the Somogyi Effect?
Blood sugar drops low in the night due to too much bedtime insulin or too small of a bedtime snack, causing liver to release more glucose
Diabetes Education: What should the patient focus on for home monitoring?
Monitor for DKA if BG above 240.
Look at Glucose and Ketones
Diabetes Education: What does ketones in urine indicate?
Indicates that the patient does not have enough insulin
Diabetes Education: How should insulin be stored?
Refrigerated if not used within 30 days
Diabetes Education: What are some exercise precuations ?
DO not exercise if BG above 250 or ketones present
Eat 15 g carb snack before exercise
Monitor for post exercise hypoglycemia
Diabetes Education: Sick Day Management includes what?
Hyperglycemia can occur from illness or stress -> Increased need for insulin
Increase fluid intake
Diabetes Education: WIth sick day management, when should patient call doctor?
If ketones presenet, unable to eat for 24 hours, or Vomiting/diarrhea for 6 hours
Diabetes Education: How many calories should come from carbohydrates?
50-60%
Diabetes Education: How many calories should come from fat and protein?
Fat: 20-30%
Protein:: 10-20%
Diabetes Education: How much fiber should you have daily?
25 g
Diabetes Education: What is the Glycemic index?
How quickly a food elevates BG
Diabetes Education: How to lower GI?
Combine starchy foods with proteins or fat
Raw or Whole Foods
Eat whole fruits rather than juices
Diabetes Education: What does fiber do to glucose?
Slows absorption of glucose
Medical Management of Diabetes: Ho to treat Type 1?
Insulin
Medical Management of Diabetes: How to treat Type 2?
Inital tx is dietary changes and exercise.
Oral Hypoglycemic agents,
Insulin needed in some cases
Medical Management of Diabetes: When is oral antidiabetic agents use?
Used for Type 2 diabetes when diet adn exercise were not effective
Medical Management of Diabetes: Side effect of oral antidiabetic agents?
Hypoglycemia
Medical Management of Diabetes: What do Pumps use?
Fast acting insulin-novolog or Humalog
Medical Management of Diabetes: How often should you rorate insulin pump sites?
Every 3 days
Medical Management of Diabetes: What are some rapid acting drugs
Lispro, Aspart (NovoLog), Glulisine (Apidra)
Medical Management of Diabetes: What are short acting drugs?
Regular (Novolin-R)
Medical Management of Diabetes: What are some intermediate acting drugs?
NPH, Detemir
Medical Management of Diabetes: What are some long acting drugs?
Glargine
Medical Management of Diabetes: Why are statins used?
To decrease leipid levels to prevent complications
Medical Management of Diabetes: Why is ASA used?
lower cardiovascular risk
When diet adanced to include liquids, patietns with diabetes recieve much more…
simple carbohydrate goods, such as juice and gelatin deserts
Enteral Tube feeding formulas contain more of what?
Simple carbohydrates and less protein and fat than the typical meal plan for diabetes. REsults in increased levels of glucose
