Diabetes pt 4

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  1. Why do patients get hypoglycemic
    because the patient didn't eat or they got too much insulin
  2. Dawn effect
    occurs  in the morning hours during sleep we have circadian rhythm  that starts to waken us. During this period there is  more production of growth hormone ( around 5-6 am) We also have cortisol being produced in a higher amount  and this leads to higher level of blood glucose.

    so this  hyperglycemia occurs because of  cortisol and growth hormone

     book says normal BG until about 3AM
  3. How do you treat the dawn  phenomenon
    You would treat with insulin when you find the patient hyperglycemia at that point in time

    change time of injection of evening intermediate acting insulin from dinner time to bed time.
  4. somogyi effect
    • Nurses find this more often that physicians 
    • the patient  gets a dose of insulin in the evening or hour of sleep. 
    • They have a "dip" in blood glucose some where between 2:30 am to 4:00am because of the insulin we gave them.
    • the body is smart and uses counter regulatory methods ( glucagon and gluconeogensis) and we end up having higher glucose because the body is trying to "save our life"

    so the insulin we gave lowered the BG and our body tries to keep us alive somewhere in the middle of the night and raises it
  5. how do you treat somogyi effect
    Give short acting insulin when you find  patient in the morning

    decrease evening ( predinner or bedtime) dose of intermediate acting insulin or increase bedtime snack
  6. what does the dawn and somogyi effect have in common
    In both of these the patient has high blood glucose in the morning
  7. American diabetic diet
    1600 calories and then the recommended values in carbs fat protein
  8. illness & stressors.. 
    what should the nurse do
    what should the patients do?
    • People who have stressors need more food
    • e.g. pregnancy.. predicates turns into gestational diabetes
    • need more insulin and more cho
    • our body elevates bgm when we are stressed
  9. if you're a diabetic and you take insulin you have to continue to take it when you're stressed
    • more cho is needed
    • and  more insulin
    • if you stop taking them, the body can't function
  10. sick day rules
    • let the pt have what they want
    • emergency kit of foods you will eat
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    • blood sugar will elevate when sick because of gluconeogenisis
    • Simple sugars are better and easier to digest but it is entirely up to the patient
    • keep well hydrated.

    more insulin is needed so patient has to at least take their regular dose
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    monitor the glucose more than usual. E.g. if you used to check it 4 times a day, you should probably do it q 3-4 hours depending on how high it goes

    • Urine ketone test: turns purple/lavender if positive
    • when you're sick you need calories you can drink
    • whatever you want doesn't have to be diet coke, can be regular
  13. extreme way to check dehydration is by weighing the patient
    if they lose 1L of fluid that is 1kg loss
  14. Ketone monitoring is usually for type 1 diabetes
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    exercising means they are using more calories and need more carbs so they shouldn't exercise
  16. 1. Patient should be keeping vial of insulin at home
    2. Patient should eat easily digested food when sick but if they don't want to  let them have whatever
    3. frequent small amounts of food
    4. vomiting
    • 1. exta regular insulin should be at home: SSI uses regular insulin because it is fast acting. The vial should be kept in the fridge but if its open it should stay outside for 30 days. Do not keep insulin in hot places
    • 2. simple sugars are easily digested
    • 3.if someone doesn't feel well don't present with full meal -> no nausea
    • 4. calll doctor if vomiting a lot and nothing is going down
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    • Temp & syncope means they are getting dehydrated
    • change in loc can mean they are getting ketotic
  18. chronic complications
    • can be prevented if bgm is kept in the normal rage 60-100
    • hemoglobin between 4-6.7
  19. what are some chronic complicaations?
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    • venus insufficiency you would elevate feet
    • arterial you do not
  21. peripheral micro vascular insufficiences  & peripheral neuropathies
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  23. Hyperesthesia
    Pain/ burning on their feet or limbs
  24. wet to dry dressing only used if someone has necrotic tissue
  25. loss of sensation ..
    • makes patient at risk to infections and bruises.
    • patient should examine foot every night
  26. microvascular insuffiences and peripheral neuropathy problems cause other problems too
    • bowel and bladder incontinence
    • impotence more common in men
    • gastroporesis: decrease in peristalsis and gastric emptying
  27. high sugar levels
    decrease healing
  28. Ambulation issues are due to neuropathy
  29. Decrease in renal function:
Card Set:
Diabetes pt 4
2013-09-11 22:10:15
complications diabetes

less obvious signs of diabetes
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