Hypopatterns nutrition part 1 Flashcards
What is pattern management?
Applying results of home blood glucose monitoring to drug therapy management
Recognizing _______/______ that occur in
patterns.
Recommending appropriate __________ to address the patterns of highs and lows seen.
Follow-up on results for changes made.
highs/lows
drug therapy
Advantages of Meter Download Packages
Quickly put data in a format beneficial for pattern management
Provide graphic representation of _______
Gives a “picture” of their blood sugars
Provide other support and tools directly to PWD (people with diabetes)
Provide value added service to establish relationship with PWD (people with diabetes)
Track/_______ data for measuring outcomes Individual patients over time
Can assist you to compile data for _________ to determine impact of clinical service
trends
multiple patients
store data
So many numbers… …where to start?
Look for most ___________ FIRST
Patterns – which has most above goal
– Breakfast
– Lunch
– Dinner
– Bedtime
Reflective of previous meal or med dose
dangerous
Documentation of BS (Blood Sugars)
State RANGE of BS at specific time
State number of BS that are above
target
State the target – in what part of note? objective
Example:
Before breakfast 104-182, 6/11 <130
Before breakfast 104-182, 5/11 >130
Documentation of BS
O: am fasting 63-134, 13/28 <130
after breakfast 154-219, 7/19 >180
A: About half of blood sugars before
breakfast are in range and about half are
in range after breakfast…..
(Objective has numbers
((Assessment cannot have any numbers just words!!)
Hypoglycemia – Low Blood Glucose
_________ is defined as a blood glucose that is lower than normal.
Blood glucose less than 70 mg/dL
Hypoglycemia
Hypoglycemia
Everyone is unique –two people may have the same low blood glucose level but experience very different symptoms
Every episode is unique
Symptoms vary from episode to episode
Symptoms may begin at different glucose levels on
different occasions
Hypoglycemia unawareness
Hypoglycemia - Signs and Symptoms
Shaking/trembling
Weakness
_________/light-headed
Sleepiness
Trouble concentrating
_________
Nervous feeling
__________ speech
Sweaty, clammy skin
Intense __________
Heart “skips a beat”
Blurred vision
Nausea/queasiness
Tingling in hands/feet/lips
shaking
dizziness
Headache
Slurred speech
intense hunger
Hypoglycemia - Nocturnal
More than half of all episodes of hypoglycemia
occur during the night – and you may sleep
through it
Common Symptoms
Nightmares
Night sweats
__________/thrashing (observed by a bed partner)
Bed partner cannot ___________ you from sleep
Unexplained _________ upon waking
seizures
cannot arouse
headache
Hypoglycemia - Nocturnal
More than half of all episodes of hypoglycemia
occur during the night – and you may sleep
through it
Common Symptoms
____________
Night sweats
__________/thrashing (observed by a bed partner)
Bed partner ___________ you from sleep
Unexplained ____________upon waking
Nightmares
seizures
cannot arouse
headache
Risk Factors for Hypoglycemia
Regimen-Related
Intensive insulin regimen (_________ daily doses)
__________ glycemic goal
_________doses of insulins
Insulins with longer __________ and duration
Diabetes medications that cause hypoglycemia (e.g. sulfonylureas-glipizide, glimepride, glybuide; meglitindes-repaglinide, nateglinide
multiple
aggresive
higher doses
longer peaks
Risk Factors for Hypoglycemia
Patient-related
Advanced __________
Decreased ____________ intake in comparison to insulin dose
Erratic meal schedule or ________meal(s)
Exercise
History of ___________
______ intake
Renal dysfunction (decreased insulin clearance)
Hepatic dysfunction (decreased gluconeogenesis)
Having type ______
Error in insulin __________ (injecting incorrect dose,
waiting >15 minutes to eat after injecting rapid-acting insulin)
age
carbohydrate intake
missed meals
hypoglycemia
alcohol
type 1 diabetes
administration
Hypoglycemia – Rule of 15
Treat with 15 gm of fasting-acting carb,
wait 15 minutes,recheck BS, retreat if
needed.
Seek help if severe or not responding to
treatment
Hypoglycemia – Rule of 15
As soon as you suspect hypoglycemia, check your
blood glucose – Do not Delay
If your blood glucose is below target, promptly
eat or drink 15 grams of _____________
carbohydrate.
Wait 15 minutes, and then recheck your glucose
level
fasting acting carbohydrate
Examples of 15 grams of Fast Acting Carbohydrate
__________ tablets (4 tablets)
_______ juice (4 oz,______ cup)
Milk (8 oz)
__________soft drink (4 oz, _____can)
Sugar (3 to 4 teaspoons/packet or 1 Tbsp)
Hard Candy (3 or 4 pieces, depending on size)
Lifesavers (5-6 pieces)
Jelly (1 Tbsp)
glucose tablets (4 tablets)
fruit juice (1/2 cup)
Non-diet soft drink (1/2 can)
What to Do at Recheck
At recheck, if glucose level still below target, ________ carbohydrate treatment (even if your
symptoms have resolved)
At recheck, if glucose level is within target, do
not eat or drink any more carbohydrates (even
if you still have ________)
After treating hypoglycemia, monitor your
blood glucose periodically over the next ________
to check for a relapse
repeat
symptoms
hour
Hypoglycemia – Over Treating
Let your ___________ readings drive your actions, not just your symptoms.
Symptoms may persist for a while, even after the glucose has corrected
Give your body time to readjust to the change in glucose level
If you’re in a situation where checking your glucose level is not possible, go ahead and take the 15 grams of carbohydrate in this case based on symptoms , you must assume that you have hypoglycemia.
glucose readings
Hypoglycemia - Prevention
If you experience hypoglycemia, monitor your glucose for the next day or two as one episode can lead to fewer warning symptoms if another episode occurs with the next 24 hours
Eat meals and snacks on time. During waking hours, don’t go more than _____hours without some nutrition
If you take insulin that peaks during your sleeping hours, be sure to eat a bedtime _____
Balanced increased activity with ______ intake
If you drink alcoholic beverages, use in moderation and _______ while drinking
don’t go more than 5 hours
bedtime snack
food intake
eat
Brief Counseling Tips
Ask for and review food and physical activity
records
Review goals, problems and solutions
Ask individuals what they need to do
Promote realistic expectations
Write down and set realistic lifestyle goals—not weight loss goals—based on readiness to change
Give positive ___________; never criticize
Look for and recommend ________ systems
encouragement
support systems
