Diabetes

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Author:
BrigittaLisPanther
ID:
111656
Filename:
Diabetes
Updated:
2011-10-25 18:02:01
Tags:
Diabetes insulin
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Description:
Diabetes, insulin
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  1. Characteristics of type 1 diabetes
    • –Autoimmune Disease
    • –Juvenile Onset
    • –Destruction of Beta cells and Islets of Langerhaun
    • –No insulin production
    • –Exogenous Insulin
    • –Relatively fast onset
  2. Characterestics of type II diabetes
    • –Metabolic Disease
    • –Adult Onset
    • –Insulin Resistance
    • –Oral medication
    • –Exogenous Insulin in some cases
    • –Slow onset
  3. What are the steps of what happens with insulin when you're type I diabetic?
    • 1. The stomach changes food into insulin
    • 2. Glucose enters the bloodstream
    • 3. The pancrease makes little or no insulin
    • 4. Little or no insulin enters the bloodstream
    • 5. Glucose builds up in the bloodstream
  4. What does insulin resistancve increase with?
    • –Age
    • –Family history
    • –Central obesity
    • –Lack of routine activity
  5. How does fat play a role in diabetes?
    • - Fat makes the body resistant to insulin and diabetes is harder to control
    • - Fat damages the pancreas, making diabetes worse
    • - Fat causes arthritis, cancer, and high blood pressure
  6. What are some tools to manage diabetes?
    • - Food choices/healthy eating
    • - Routine activity
    • - Routine blood glucose monitoring
    • - Routine use of prescribed medications
    • - Stress reduction strategies
    • - Practice good habits (smoking cessation)
  7. What are factors that increase/decrease blood glucose?
    • Increase: food, stress, illness
    • Decrease: Activity, medications
  8. What are some benefits of physical activity for diabetics
    • –Lose/maintain weight
    • –Reduce insulin resistance
    • –Lower blood glucose
    • –Improve blood cholesterol levels
    • –Lower blood pressure
    • –Improve circulation
    • –Reduces effects of stress/stress hormones
  9. What is normal blood glucose?
    • –Before meals (60-100 mgs/dl)
    • –After meals (60-120 mgs/dl)

  10. What is target DM glucose
    • –Before meal (70-110 mgs/dl)
    • –After meal (90 to 150 mgs/dl)
  11. Symptoms of hypoglycemia
    • Confusion
    • Clamminess
    • Irritability
    • Shakiness
    • Erratic heartbeat,
    • Dizziness
    • Unexplained fatigue,
    • Hunger
    • Potential loss of consciousness
  12. Hyperglycemia
    • Irritability
    • Thirsty
    • Frequent Urination
    • Increased Hunger
    • Fatigue
    • Headache
    • Weight loss
    • Infections that won’t heal
    • Vision changes
  13. What is hypoglycemia?
    - BG below 70mg/dl
  14. What is the rule of 15?
    • If you check your bg and it's below 70, take 15 grams of carbs.
    • 15 minutes later check it again. If it's still below 70, take another 15 grams of carbs. 15 minutes later check it again... etc.
  15. What are some items that contain 15 grams of carbs
    • 3–4 glucose tablets
    • 1 dose of glucose gel (in most cases, 1 small tube is one dose)
    • 1/2 cup of orange juice or regular soda (not sugar-free)
    • 1 tablespoon of honey or syrup
    • 1 tablespoon of sugar or 5 small sugar cubes
    • 6–8 LifeSavers
    • 8 ounces of skim (nonfat) milk
  16. Hyperglycemia
    BG above 180mg/dl
  17. What must one have to be diagnosed with diabetic ketoacidosis?
    • –Uncontrolled hyperglycemia (>250mg/dL)
    • –Ketosis
    • –Acidosis
  18. How is diabetic ketoacidosis treated?
    • –Fluids/Electrolytes
    • –Insulin Drip
    • –Mortality 9%
  19. What are signs and symptoms of diabetic ketoacidosis?
    • –Nausea/Vomiting
    • –Frequent Urination
    • –Tachycardia
    • –Kussmal Respirations
    • –Abdominal pain
    • –Confusion
    • –Breath that smells fruity
    • –Fever
    • –Unconsciousness
    • –Fatigue
  20. Why does diagnosis with hyperosmolar nonketotic coma include?
    • –uncontrolled hyperglycemia above 600mg/dl
    • –Hyperosmolality
    • –Prolonged dehydration
    • –Absence of ketones
  21. What are some signs and symptoms of hyperosmolar nonketotic coma?
    • -Fatigue
    • –Excessive thirst/dehydration
    • –Disorientation and Confusion
    • –Sudden hypotension
    • –Visual problems
    • –Fever
    • –Coma, Seizure, Hemiplegia
  22. What are some treatments for hyperosmolar nonketotic coma?
    –Fluid Resuscitation

    –Insulin

    –High Mortality Rate 10-50%
  23. What are some immediate acting insulins?
    –Apidra
  24. –Humalog/Novalog
  25. What are some moderate acting insulins?
    –Novalin/Regular
  26. –NPH
  27. What are some long-acting insulins?
    –Lantus/Levimir
  28. What are some mixed insulins?
    • –Novalin 70/30
    • - Novalog 70/30
  29. Most important nursing consideration for insulin?
    Monitor for hypoglycemia
  30. Byetta
    –Helps the body to release more insulin

    –Reduces glucose released by the liver

    –Moderates appetite

    –Reduces post prandial bgs
  31. Symlin
    • –Moderates appetite
    • –Reduces post prandial bgs
    • –May decrease overall amount of bolus insulin required
  32. Nursing considerations for injectables
    –May cause GI upset

    –May cause substantial hypoglycemia
  33. What are some oral meds that work on the pancreas?
    –Amaryl

    –Glucotrol

    –Glipizide

    –Glimipiride

    –Glyburide
  34. How do these pancreas meds work and what are some nursing considerations?
    –Help the pancreas to release more of its own insulin
  35. Nursing considerations: may lower BG if meals are missed/late
  36. What are some medications that work on the liver?
    –Metformin

    –Glucophage
  37. How do these liver meds work, what are some nursing considerations?
    • –These keep the liver from making extra sugar when not needed, or “controls leaky storage”
    • Nursing considerations:

    –Hold if patient is to go to receive contrast media

    –Hold if pt has nausea, diarrhea or is not eating

    –Take with food to avoid nausea
  38. What are some oral meds that work on the cellular level?
    –Avandia

    –Actos
  39. How do these oral meds that work on a cellular level work? What are some nursing considerations?
    • –These help muscle cells become more sensitive to insulin by making new keyholes.
    • nursing considerations: May cause fluid retention
  40. Januvia
    An oral med that works on a cellular level in the liver/pancreas

    • –These help match insulin to food and keep the body from releasing sugar from storage
    • while sugar comes from the gut.
  41. Oral diabetes meds that work on digestion
    –Precose
  42. –Glyset
  43. How do oral meds that work on digestion work? What are some nursing implications?
    How it works
  44. –Slow digestion of starch and sugars to reduce post prandial blood glucose levels.
  45. Nursing Considerations
  46. –May cause bloating or gas
  47. What should you know about nutrition facts?
    • - You should get between 5 and 20 percent of daily value
    • - Limit total fat, sodium, and cholesterol
    • - Get enough potassium, fiber, Vts A, C, calcium, and iron
  48. Carb sources
    • -Starch
    • -Fruit
    • -Milk
    • -Sweets
  49. Carb portions
    110-130 grams daily for adults (45/60/60)
  50. Diabetes complications
    • - Stroke
    • - Eye damage
    • - Heart attack
    • - Kidney damage
    • -Impotence/Difficulty passing urine
    • - Numbness and reduced blood supply
  51. Preventative measures for diabetes
    • -Exercise
    • -Diet planning
    • -Routine labs
    • -Foot exams
    • -Dental exams
    • -Eye exams
    • -Blood pressure
  52. Routine labs for diabetes
    –A1C

    –Lipid panel

    –Microalbuminuria

    –Creatnine

    –BUN

    –LFT’s
  53. What bp meds are used w diabetes?
    • - ACE inhibitors
    • - statins
  54. What are normal, safe, OK, and unsafe blood sugar ranges before meals?
    • Normal: 60-100
    • Safe: 80-100
    • OK: 80-120
    • Unsafe: over 140
  55. What are normal, safe, OK, and unsfe blood sugar 1-2 hrs after meals?
    • Normal: 90-120
    • Safe: 100-140
    • OK: 100-180
    • Unsafe: Over 180
  56. What are normal, safe, ok and unsafe HbA1c levls?
    • Normal: below 6% (4 to 5)
    • Safe: below 6.5 %
    • OK: below 7%
    • Unsafe: over 8%
  57. To reduce the risk of heart disease it is important to keep blood pressure below ____ and lower_____
    130/80, blood fats
  58. What re the new diagnosis standards for pre-diabetes and diabetes fasting blood sugars?
    • Pre-diabetes: fasting blood sugar 100-125
    • Diabetes: fasting blood sugar 126 or over
  59. Blood pressure: how often? goal?
    • - Every visit
    • -130/80
  60. Weight: How often?
    every visit
  61. Feet: how often? goal?
    • every visit
    • no cuts/sores/sensation intact per monofilament
  62. A1c: how often? goal?
    • Every 3 months
    • under 6.5%
  63. Cholesterol: how often? goal?
    • Every year
    • under 200 mg/dl
  64. Triglycerides: how often? goal?
    • Every year
    • under 150 mg/dl
  65. HDL (healthy): how often? goal?
    • every year
    • 55 mg/dl or over
  66. LDL (lousy): how often, goal?
    • How often: every year
    • Goal: under 100 mg/dl, under 70 mg/dl
  67. VLDL (very lousy): how often? goal?
    • every year
    • under 40 mg/dl
  68. Microalbuminuria/kidneys: how often? goal?
    • Every year
    • 30 mg/24 hrs
  69. Eyes: how often? goal?
    • Every year
    • No retinal changes
  70. How many carbs should women eat for meals and snacks?
    • Meals: 30-60 grams(limit to 45 grams for weight loss)
    • Snacks: 15-30 grams (15-20 grams for weight loss)
  71. How many carbs should men eat for meals and snacks?
    • Meals: 45-75 grams (limit to 60 grams for weight loss)
    • Snacks: 15-30 grams (15 to 25 grams for weight loss)
  72. Rapid-acting analogs
    • Humalog
    • novolog
    • apidra
  73. Humalog
    • Color: clear
    • Starts working: 15 minutes
    • Works best: 45 minutes to 1-3 hours
    • Is gone: 4-6 hours
  74. NovoLog
    • Color: clear
    • Starts working: 15 minutes
    • Works Best: 45 minutes to 1-3 hours
    • Is gone: 3 to 5 hours
  75. Apidra
    • Color: clear
    • Starts working: 15 minutes
    • Works best: 40 minutes ot 1-2 hours
    • Is gone: 3-5 hours
  76. Exubera
    • Inhalable
    • Color: powder
    • Starts working: 10 minutes
    • Works Best: 10 min to 5 hours
    • Is gone: 8 hrs
  77. Rapid-acting Analog Mixtures
    Humalog 75/25

    • Humalog 50/50
    • Novolog 70/30
  78. Humalog 75/25 and Humalog 50/50
    • Color: Milky white
    • Starts working: 15 to 30 mins
    • Works best 1 to 61/2 hours
    • Is gone: 22 hrs
  79. NovoLog 70/30
    • color: milky white
    • Starts working: 15-30 minutes
    • Works best 1 to 4 hours
    • Is gone: in 24 hours
  80. Long-Acting Analog
    • Lantus
    • Levemir
  81. Lantus
    • color: clear
    • Starts working: 1 hour
    • Works best: no peak
    • Is gone: 11-24 hours
  82. Levemir
    • Color: clear
    • Starts Working: 1 hour
    • Works Best: no peak
    • Is gone: 6-23 hours
  83. Short-acting
    Regular* (action is related to amount of insulin given in one dose, larger doses start to work slower and last longer, smaller doses start faster and don't last as long. The action is also effected by the injectin location or site.)
  84. Regular*
    • Color: clear
    • Starts working: .5 hr - 1 hr
    • Works best: 2 to 5 hrs
    • Is gone: 6 to 16 hrs
  85. Intermediate acting
    • NPH*
    • Lente*
  86. NPH*
    • Color: milky white
    • Starts working: 1-2 hrs
    • Works best: 4 to12 hrs
    • Is gone: 12 to 24 hrs
  87. Lente*
    • Color: milky white
    • Starts working: 1-2.5 hrs
    • Works best: 6-15 hrs
    • Is gone: about 22 hrs
  88. Mixtures
    70/30*
  89. 70/30*
    • color: milky white
    • Starts working: .5 to 1 hr
    • Works best: 2-12 hrs
    • Is gone: 24 hrs

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