diabetes mellitus

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created 2 years ago by Akosua_Ruby
updated 2 years ago by Akosua_Ruby
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  • rapid onset.
  • caused by not enough PO intake, too much insulin, exercise, lipodystrophy

goals for diabetes management

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

patient teaching

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

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

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)

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


adverse effects of insulin

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

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


dawn phenomenon

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


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

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


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

manifestations of hypoglycemia

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


insulin pump

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

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)

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

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