diabetes mellitus

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1

hypoglycemia

  • rapid onset.
  • caused by not enough PO intake, too much insulin, exercise, lipodystrophy
2

goals for diabetes management

  • reduce symptoms
  • promote well-being
  • prevent acute complications
  • delay long-term complications
3

patient teaching

  • nutritional therapy
  • glucose monitoring and medications
  • exercise
  • sick day guidelines
  • foot care guidelines
4

drug therapy (insulin) for type 1 and type 2

required for type 1

for type 2:

  • if unable to control glucose through diet, exercise, wt control, and OAs
  • during time of stress
  • as disease progesses
5

how to store insulin

in-use vials/pens are okay at room temp for up to 4 weeks. refrigerate unopened insulin, no freezing or heat and do not inject cold.

  • administer subcutaneously
  • IV only in emergency situations (regular insulin only)
6

what is the preferred site of injection?

abdomen. rotate injections within one particular site to avoid atrophy of fat or muscle every 2-3days. do not inject in site to be exercised and wait a while before exercising after injection. decrease dosing with exercise

7

adverse effects of insulin

  • hypoglycemia
  • allergic reactions
  • lipodystrophy
  • somogyi effect
  • dawn phenomenon
8

the somogyi effect

you're getting too much insulin with night time dose. blood sugar gets really low between 2-4am. body reverses it and it's not when you wake up. bed time snack or decrease nighttime dose to reverse it

9

dawn phenomenon

blood sugar high in the morning, therefore, they need more nighttime insulin. check sugar between 2-4am, it'll be high

10

nutritional therapy for diabetes

  • carbohydrates: include whole grains, fruits and vegetables, low fat dairy. fibers 25-30g/day
  • glycemix index: causes BS to rise real fast, foods like starchy foods
  • fats: limited transfat. cholesterol < 200mg/day
  • protein: limit because the more you have the more your kidneys have to work
  • limit alcohol: liver is too busy breaking down alcohol not able to spill out glucose
11

nursing management: DKA and HHS

  • correct fluid/electrolyte imbalance (normal saline)
  • insulin drip IV after fluid resuscitation
  • potassium replacement
  • treatment for both except HHS requires greater fluid replacement
12

hypoglycemia

  • rapid onset.
  • caused by not enough PO intake, too much insulin, exercise, lipodystroph
13

manifestations of hypoglycemia

pallor, diaphoresis, cool skin, fatigue, hunger, irritability, lethargy, headache.

14

insulin pump

  • continuous subcutaneous infusion (rapid acting insulin)
  • bolus at mealtime
  • potential for tight glucose control
  • glucose monitoring 4-6 times/day
15

treatment of hypoglycemia

  • if they are alert enough to swallow, give them simple carb, avoid foods with fat.
  • if they are not alert, give dextrose 50% IVP (20-50ml)
16

sickness guidelines

  • continue regular meal plan
  • increase intake of noncaloric fluids
  • continue taking oral agents and insulin
  • monitor glucose at least every 4 hrs
  • ketone testing if glucose is > 240mg/dl
17

difference between DKA and HHS

  • DKA you get fuity breath, kussmaul respirations, metabolic acidosis, ketones in blood and urine
  • HHS normal breath, normal respiration, normal ABGs and absent or minimal urine