ATI Fundamental of nursing Diabetes management

Diabetic types
Type 1- is the destruction of the beta cells of the pancreas
Type 2- cellular insulin resistance and impaired insulin secretion
Gestational- manifest during pregnancy, may resolve after delivery and weight loss
Type 1 diabetes symptoms
and unexplained weight loss
fasting blood sugar greater than 110 mg/dl
random plasma blood glucose greater than 200 mg/dl
fasting blood sugar below 60 mg/dl
hypoglycemia characterization
pallor, tremor, diaphoresis (sweating), palpitations, hunger, visual disturbances, weakness, paresthesias, confusion, agitation, coma and death
Diabetic ketoacidosis (DKA) C
medical emergancy often present with a glucose level above 300 mg/dl
common in people with type 1 diabetes
Characterization of ketoacidosis
hyperglycemia, ketones in the urine, an increased respiratory rate, and a fruity breath odor.
Hyperglycemic-hyperosmolar state
medical emergency common with people with type 2 diabetes
Blood glucose level typically above 600 mg/dl
Characterization of Hyperglycemic-hyperosmolar
hyperglycemia, only slight or no ketosis, and profound dehydration
slow to heal, common found in the skin, urinary tract and vagina
Macrovascular complications
coronary artery disease, cerebrovascular accident and peripheral vascular disease

increases the risk of early death

microvascular complications
retinopathy, neuropathy and nephropathy
Diabetes in pregnancy
high risk of perinatal infant mortality and congenital anomalies
High risk for larger birthweight babies, perinatal hypoglycemia, respiratory distress, hypertensive disorder, cardiac dysrhythmias
Treatment of type 2 diabetes
1. exercise and diet therapy
2. initiate therapy with one oral hypoglycemic. medication depends on body composition and severity of hyperglycemia
3. treat with two oral hypoglycemics or with one oral hypoglycemic plus insulin
5. treat with insulin alone
increase insulin secretion by the beta cells of the pancreas

side effects weight gain and hypoglycemia

combination drugs used with:
metformin (glucophage) thiazolidinediones, alpha- glucosidase inhibitors

Common drug names- glyburide (Micronase) glipizide (glucotrol) and glimepiride (Amaryl).

Meglitinides (glinides)
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