Week 3 Diabetes Flashcards
How does T1D work?
How does T2D work?
T1D facts
- More common in younger people
- S/S normally more abrupt
- NO endogenous insulin production -> must have insulin replacement
- 3 Ps most common: polyphagia, polydipsia, polyuria
T2D Facts
- More common in adults (w/ risk factors)
- Can go undiagnosed for years
- Drs just screen for risk factors, not s/s
- Pts are INSULIN RESISTANT —> treat w/ oral/SQ meds, may need insulin replacement
Symptoms of T2D
Fatigue, recurrent infections (decreased immune system), slow wound healing
What are the 3 Ps associated with T1DM?
Polydipsia, polyuria, polyphagia
Non-modifiable risk factors for T2D
- Family hx of diabetes
- > 45 years old
- Race/Ethnicity
- Hx of gestational diabetes
Modifiable risk factors for T2D
- Physical inactivity
- High body fat or body weight
- High BP
- High cholesterol
Labs involved in diabetes:
Fasting
Casual
Urine ketones
Lipid profile
Fasting - No food/drink in 8 hours <126 mg/dL
Casual - <200 mg/dL
Urine ketones - high = hyperglycemia >300
HDL >50 LDL <130 Total <200
Oral Glucose Tolerance Test & Lab Values
- Gestational Diabetes
- Fasting, oral glucose, levels obtained every 30 min until 2 hours post consumption
- Fasting <110 mg/dL
- 1 hour - <180 mg/dL
- 2 hours - <140 mg/dL
HbA1C
Indicated for AVG glucose level over past 120 days (3 mos)
Used commonly for diagnosis and to evaluate effectiveness of interventions (meds/lifestyle)
Normal 4-6% Diabetic >6.5%
*Acceptable reference range for those w/ diagnoses DM, 6-8% range -> w/ target of 7%.
Blood Test Levels for Diagnosis: A1C
Normal: 4-6%
Pre-Diabetes: 5.7 - 6.4%
Diabetes: >6.5%
Blood Test Levels for Diagnosis: Fasting
Normal: 99 or below
Pre-Diabetes: 100 - 125
Diabetes: 126 or above
Blood Test Levels for Diagnosis: Oral Glucose Tolerance Test
Normal: 139 or below
Pre-Diabetes: 140 - 199
Diabetes: 200 or above
Diagnostic Criteria for T1D and T2D
T1D: islet cell antibody test
T2D: At least one of the following: - A1C 6.5 or higher - Fasting >126 - OGTT 200 mg - 3 Ps - Random glucose test of >200
Care for Pre-Diabetic Patient
Defined as impaired glucose tolerance, impaired fasting-glucose, or both.
No symptoms although long-term damage may already be occurring
Diagnostic criteria:
- A1C: 5.7 - 6.4
- Fasting: 100 - 125
- OGTT: 140 - 199
What can we do for these pts?
- Teach
- Lifestyle modification
- Close monitoring of A1C
- Monitor for s/s: fatigue, slow wound healing, getting sick
What medications are used more frequently in T2D patients?
Oral medications
Try to:
- Reverse insulin resistance
- Decrease insulin production
- Increase hepatic glucose production
What happens to hospitalized pts that are previously on oral diabetic meds?
They are put on insulin while acutely ill.
What do steroids do to your blood sugar?
Make it rise
Patients are more prone to what when they are sick?
T1D?
T2D?
T1D -> DKA - diabetic ketoacidosis
T2D -> HHNS - hyperosmolar hyperglycemic syndrome
What happens when a pt w/ DM gets sick w/ a virus?
- May not be eating or drinking.
- Must check blood sugar often and treat as necessary
- Still need to take oral meds if sick, if possible
What are some teaching points for pts when they are sick and have DM?
- Notify HCP
- Monitor BS more frequently (q2-4h)
- Cont. to take meds
- Prevent dehydration
- Meet carb needs -> either via food or liquid
- Rest
When should the pt call their HCP when they are sick and have DM?
- Ketones in urine
- BS >250
- Fever >101.5 & is not responding to Tylenol
- Confused/disoriented/rapid breathing
- Persistent N/V/D
- Unable to tolerate liquids
- Illness lasting longer than 2 days
Basal insulin vs bolus
Basal - Long-time insulin
Bolus - “Mealtime” insulin -> rapid and short acting
Why do we give basal-bolus combos for insulin?
To mimic the body’s normal insulin production
Rapid-Acting Insulin
Lispro (NovoLOG)
Onset: 15 min
Peak: 1 hour
Duration: 2-4 hours
Regular/Short Acting Insulin
Human regular (Novalin R/Humalin R)
Onset: 30-60 min
Peak: 2-6 hours
Duration: 3-8 hours
Intermediate Insulin
NPH (Humalin N)
Onset: 2-4 hours
Peak: 4-10 hours
Duration: 10-20 hours
Long Acting Insulin
Glargine (Lantus)
Onset: 70 min
Peak: None
Duration: 24 hours
Is Insulin a high alert medication?
Yes!
What do you do before giving insulin?
1st - Check current glucose levels
2nd - Check diet order & pts oral intake tolerance
Know onset, peak, duration of insulin and the type you’re giving
Monitor for hypoglycemia
What BG levels are for hypoglycemia?
<70
Can show symptoms if greater than 70 depending on if the diabetes is uncontrolled
How do you treat hypoglycemia?
- Check FSBG levels
- The rule of 15 (if conscious and able to swallow)
- Recheck FSBG levels in 15 min, then eat regular meal w/ protein
- If still >70, repeat. When glucose stable, give additional food.
What is the “Rule of 15”?
- 15 simple CHO (4 oz juice, regular soda, 3 glucose tabs, 1 tbsp honey, 5-8 lifesavers)
- Avoid sugars w/ fat (candy bar) because it delays absorption
*15g of CHO should raise BG levels by 50!!
What do you do if the pt is hypoglycemic and unconscious?
IM glucagon
IV D50
What are the levels for hyperglycemia?
> 250 - 300
What causes Hyperglycemia?
Illness, infection, self-management issues, stress
What are s/s of Hyperglycemia?
Weakness, fatigue, blurry vision, headache, N/V/D
What is the treatment for hyperglycemia?
- Check for ketones in urine
- Insulin
- Drink fluids, prevent dehydration
- Education on prevention
Insulin pumps
- T1D
- Rapid acting insulin
- Pts receive continuous basal infusion
- Required to check BS 4TID
- Deactivated in hospital and switched to sliding scale
- Cost $$$$$$
Chronic complications of Diabetes:
Macrovascular
Microvascular
Macrovascular
- Damage to lg vessels
- coronary arteries
- peripheral vascular
- cerebral vascular
Microvascular
- Damage to capillaries
- Retinopathies
- Nephropathies
- Neuropathies
Macrovascular disease facts
- Women w/ DM have 4-6x more risk of CVD
- Men have 2-3x risk of CVD
Educate!
- PREVENTION
- Stop smoking, control BP, modify high fat diet
Microvascular disease complications
Retinopathy
- Damage to retina
Nephropathy
- Damage to small blood vessels in kidneys
- Leading cause of end stage renal dz.
Neuropathy
- Nerve damage due to metabolic imbalances
- 60-70% of patients have
What are the highest risks for neuropathy in DM pts?
- Lower extremities and feet
- Foot ulcers and lower amputations common
Diabetic foot care
- Wash feet daily
- Pat feet dry, esp between toes
- Inspect feet daily for cuts, swelling, blisters, red areas
- Lanolin to prevent dry skin and cracking, but not between toes
- Mild foot powder on sweaty feet
- Do not use commercial remedies to remove calluses or corns
- Clean cuts w/ mild soap
- Report skin infections or no healing sores
- Trim nails after shower or bath and round corners
- Separate overlapping toes w/ cotton
- Do not go barefoot, wear open-toes, or plastic shoes. Shake soles before wearing regular shoes.
- Clean, absorbent socks
- No hot water bottles
Nutritional Concerns for Diabetes
- Balanced, high fiber, low fat, low cholesterol diet
- Encourage clients to consume grains/fruits/legumes/milk
- Limit simple carbs -> pasta and bread
- CHO: 45-65% of intake
- Fats: low in sat fat and trans fat; polyunsaturated fats best (fish)
- Fiber: Promote fiber intake (beans, veggies, oats, whole grains)
- Protein: Promote intake from meats, eggs, fish, nuts, and beans; 15-20% intake
- Alcohol: limit intake; 1 daily for women, 2 for men
Exercise for DM patients
- Exercise can LOWER blood sugar
- Do not exercise if glucose is >250 OR <80
- Best to exercise after meals
- If more than 1 hour has passed since eating, eat CHO snack prior
- Wear a medical alert bracelet
- Proper fitting footwear
Nursing considerations for the hospitalized diabetic patient
- Stress/surgery can increase blood glucose levels
- Common to be controlled at home but uncontrolled at the hospital
- Wound healing is impaired in pts w/ DM
- High risk of infection
Integumentary Concerns r/t DM
Diabetic dermopathy: reddish brown spots, shins
Acanthosis nigricans: brown/black thickening of skin, skin folds
Necrobiosis lipoidica diabeticorum: Red patches around blood vessels
