Diabetes Mellitus

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Author:
vanwin
ID:
251516
Filename:
Diabetes Mellitus
Updated:
2013-12-08 18:08:04
Tags:
diabetes medsurge nursing
Folders:
MEDSURG_E3
Description:
nursing medsurge uttyler, don't go here
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  1. Risks for diabetes
    • obesity
    • highfat diet
    • sedentary lifestyles
  2. Diabetes Type I Patho (6)
    • Juvenile onset
    • genetic disposition
    • autoimmune disorder
    • long, preclinical period
    • *DKA in ER
    • *indulin depedent
  3. Type II diabetes causes(4)
    • insulin resistance
    • decrease insulin production by the pancrease
    • increased glucose production by liver
    • altered hormones by adipose tissue
  4. Type II Risk factors
    • Obesity
    • sedentary lifestyle
    • urbanization
    • ethnicity ( native americans, AA & hispanics)
  5. Metabolic Syndrome (6)
    • *increases chance of developing type 2DM
    • high triglycerides
    • HTN
    • ^ in LDLs
    • decreased in HDLs
    • insulin resistance
  6. Type I DM clinical manifestations
    • Polyura
    • Polydipsia
    • Polyphagia
    • *weakness & fatigue
    • sudden weight loss
  7. Type II DM clinical manifestation (4)
    • fatigue
    • recurrent infections
    • delated wound healing
    • visual changes
  8. Diabetes Diagnostic Testing (4)
    • fasting blood sugar
    • random blood sugar >200
    • 2 hour glucose tolerance test
    • HgbA1C - 6.5
  9. Fasting plasma glucose
    • pt NPO for 8 hrs
    • 70 - 110 is normal
    • 111-125, impaired fasting glucose; prediabetic
    • >126 twice in a row = DM
  10. Random plasma glucose
    • >200 and has to have s&s of hyperglycemia
    • polyura
    • polydipsia
    • polyphagia
  11. 2- hourr oral glucose tolerance test
    • *given loading dose, after 2 hr glucose should be back to normal range
    • 110 - 139 - normal
    • 140 - 199 - prediabetic
    • >200 DM
  12. Diabetes pt teaching
    • Characteristics of their insulin
    • when & how to check bs
    • urine testing - ketones
    • medical ID
    • s&s of hypo/hyperglycemia
    • foot care
    • meds
    • sick days
  13. Goals of diabetic treatment (3)
    • HgbA1C  < 7
    • fasting blood glucose 90 - 130
    • post prandial blood sugar <180 (2 hours after eating)
  14. Diabetic treatment Team (6)
    • RN
    • Nutritionist
    • Podiatrist
    • opthalmologist
    • exercise therapy
    • endocrinologist
  15. Diabetic lab values
    • Hgb
    • Hct
    • albumin
    • iron
    • lipids
  16. Type I diabetic nutritional therapy (3)
    • adjust insulin according blood sugar
    • watch carbs
    • balance diet with exercise
  17. Type II diabetic nutritional therapy
    • achieve things wdl
    • lipids
    • glucose
    • blood pressure
    • hgba1c
    • loose weight
  18. Diabetic food composition
    • cholesterol <300
    • Na <2400grams/day
    • fiber 25-30grams / day
  19. Diabetic risks of exercise
    • *hypoglycemia!
    • eat 15 grams of carbs w/in 30 mins of exercise
    • exercise 1 hr after meals
  20. Diabetic exercise guidelines
    • *after meal ( 1hr), checkk bs
    • <100 - eat 15 gr carbs, retest in 30 mins, if <100 again don't exercise
    • >240 - check for ketones, positive - dont exercise
    • >300 dont exercise
    • *hypoglycemia can occur up to 48 hrs after exercise
  21. Diabetics, foods to avoid
    • alcohol
    • simple sugars
    • adding sugars to foods
    • excess sodium
  22. When to check blood sugars ( 6)
    • before meals
    • before & after exercise
    • suspects hypoglycemia
    • Q4H when sick
    • maybe HS
    • after meals (2hrs)
  23. Gliptizide ( Glucotrol) MoA, SE & nursing implications
    • *sulfonylurea
    • MoA: stimulate insulin production
    • SE:  hypoglycemia & weight gain
    • Implications: give 30mins before meals, effects last 24 hrs
  24. Metformin (Glucophage) MoA, SE, implications
    • -biguanide
    • MoA: decrease glucose production & increase insulin sensitivity
    • SE: diarrhea & lactic acidosis
    • Implications: doesn't cause hypoglycemia, can be used with sulfonylureas
    • *hold 48hrs before IV contrast until creatine is WDL
  25. Acarbose (precose) MoA, SE, Implications
    • MoA: delay glucose absorption in GI
    • SE: gas, abd pain, diarrhea
    • Implications:
    • -take with first bite of meal to block glucose
    • - does't cause hypoglycemia
  26. Glitzone (actose. avandia) MoA, SE, Implications
    • MoA: increase glucose sensitivity
    • SE: weight gain and increased cardiac events
    • implications: no hypoglycemia
  27. Types of insulin
  28. Types of Combination Insulin
    • 70/30 (NPH/reg)
    • 50/50 (NPH/reg)
    • 75/25 (NPH/ lispro)
  29. Diabetic sick day managements
    • - monitor blood sugar Q4H
    • - test for ketones
    • -don't stop insulin
  30. Diabetic pre op labs
    • HgbA1C
    • CBC
    • EKG
    • CXR
    • electrolytes
    • renal function
  31. Diabetic post op care
    • IV insulin until they can tolerate PO
    • BS 4-6x/ day
    • avoid foley
    • steril dressing changes
  32. DKA patho
    • Cells starve r/t lack of insulin
    • fat & protein break down
    • gluconeogenesis
    • - both lead to ketone biproducts
  33. early DKA s&s
    • lethargy
    • weakness
    • poor skin turgor
    • dry
  34. Rapid insulin
    • onset: 5-15 mins
    • peak: 1- 1.5
    • duration: 3-4hrs
  35. short acting insulin
    • onset: 30mins - 1 hr
    • peak: 2-3 hrs
    • duration: 4-6hrs
  36. intermediate acting insulin
    • onset: 2 hrs
    • peak: 6-8
    • duration: 12-16 hrs
  37. long acting insulin
    • onset: 1-2 hrs
    • peakless
    • durationg: 24 hrs

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