Care of Patient’s with Diabetes Mellitus – Flashcards

Health care team approach -nutritional interventions -blood glucose monitoring -planned exercise -oral agents or insulin to lower blood glucose, Type 1 DM can only be controlled with insulin

-diabetes is the lack of uptake of the Beta cells of insulin, or the inability to secrete Type 1-beta cell destruction, autoimmune with absolute insulin deficiency, thin Type 2-insulin resistance-other specific conditions resulting in hyperglycemia-drug induced, infectious, genetic defects, overweight Gestational diabetes-glucose intolerance with onset or first recognition during pregnancy

health promotion-focus on controlling hyperglycemia, low calorie diet and exercise can improve cardiac and metabolic factors, tight control of blood glucose levels can prevent complications, improving weight loss, exercise and increasing HDL's can reduce the incidence of type 2 by 58% in older adults assess-HbA1c >6.5% is diagnostic, FBG-126mg/dl on 2 samples after 8 hr. fasting diagnostic, random blood glucose>200 mg/dl, OGTT-most sensitive, pregnant women, 2 or more levels are elevated, urine ketones-indicate severe lack of insulin

potential for injury R/T hyperglycemia, potential for impaired wound healing R/T endocrine and vascular effects of diabetes, potential for injury R/T diabetic neuropathy, pain r/t diabetic neuropathy, potential for injury r/t diabetic retinopathy, potential for impaired renal circulation, potential for hypoglycemia, potential for DKA-inc. sugars cause you to pass out, potential for hyperglycemic-Hyperosmolar state and coma

rapid acting-aspart, lispro (Novolog, Humalog) onset 5-15 minutes, peaks in 1-3 hrs, lasts 3-5 hrs short-acting-regular insulin, (Humulin R) onset in 30 minutes, peaks 2-4 hrs, lasts 5-7 hrs Intermediate acting-NPH insulin, (Novolin N) onset in 1.5 hrs, peaks in 4-12 hrs, lasts 16-24 hrs long-acting-insulin glargine or lantus, onset is 2-4 hrs, no peak, lasts 24 hrs-basal -Biguanides-Metformin(glucophage), controls a leaky liver, usually first drug used

Self monitoring of glucose monitoring-SMBG assists in reaching target blood glucose levels and in prevention of hypoglycemia -Home meters measure whole blood, which is 10-15% lower than lab samples -Multiple times a day is often required for multiple insulin injections-3-4x a day -talking meters for the visually impaired

total carbohydrates 45-65% and include fruits, vegetables, whole grains, legumes and low fat milk, min. of 130g per day -protein intake 15-20%, less with kidney disease -fiber to 14g per 1000 calories-monitor for hypoglycemia, AHA recommends 26 g/day -limit saturated fat to less than 7% -monitor alcohol use-2 fat exchanges, only with meals -one food group equally exchanges for another in the same group. 1 slice of bread=1/2 cup of pasta carb. counting-1 unit of rapid acting insulin covers 15g of carbohydrates-useful for insulin pumps -2 slices of toast=32g carbs -1/2 OJ is 1 exchange

older adults are at increased risk for hypoglycemia, malnutrition, and dehydration-b/c they don't eat -change in appetites, taste, smells, alot of salt -poorly fitting dentures -neuropathy and gastric retention -reduced income, being alone decreases desire to prepare healthy meals -regular visits by home health nurse can help

-Hyperglycemia increases with stress or infection, use of corticosteroids, tube feedings, parenteral nutrition -hyperglycemia are directly related to higher wound infection rates -prevention of hypoglycemia with altered nutrition -during surgery and in ICU levels may be kept btw 140-180.

-cleanse and inspect feet daily for redness, check bathwater temperatures, optimal 95 degrees F, wear proper shoes, no open toe, well-fitting, avoid walking bare-foot, get a doctor to trim toe-nails properly, cream on feet but not btw toes, report any nonhealing breaks in the skin to the health care provider

DKA-Type 1: Osmotic diuresis>dehydration, polyuria, polydipsia, polyphagia, weight loss, abdominal pain, vomiting not in hypoglycemia, altered mental status, kussmal respirations-fruity breath, shock and coma HHS-Type 2: increased blood glucose, increased blood osmolarity-end state of sustained osmotic diuresis, hypovolemia, kidney impairment, renal threshhold is exceeded, ketones are low or absent, usually seen in TII Diabetics, elderly, who are unaware

Notify the MD, monitor BGq4hrs, call MD if BG is>240 with ketones in the urine, continue to take insulin or po meds, drink every hour, non-sugar drinks to stay hydrated, continue to eat, or drink with equivalent carbohydrate amounts, like gatorade, call MD if vomiting>2x, high fever, ketones in urine, diarrhea for second day

-patient is able to achieve BG control -patient is avoiding acute and chronic complications or diabetes -good pain relief -optimal vision

a level of 70mg/dl alerts you to look for symptoms -15 to 20g of glucose, repeat in 15 min., if clinical manifestations have not improved or blood glucose is still below 70mg/dl -mild symptoms-glucose tablets/gel, 10-15g -1/2 cup of fruit juice=6-10 hard candies -1/2 cup of regular soda=4 cubes of sugar -8 oz. of skim milk=1 tbsp honey -after administering the sugar for a 2nd time, wait 15 min., and repeat BG test -for moderate hypoglycemia-cool, clammy, skin, pale, rapid breathing, drowsiness, 15-30g of sugar, then low-fat milk or cheese after 15 min. -for severe hypoglycemia-unable to swallow, unconscious>1mg of glucagon IM or SQ, repeat in 10 min.>notify MD, start IV (D10, D50) -encourage medical alert bracelet -flip on side if get nauseous, don't put anything in the mouth