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Terms in this set (79)
Primary problem of diabetes
Glucose metabolism due to abnormal insulin production and/or impaired insulin utilization.
is a multisystem disease
diabetes is the 5th leading
cause of death
leading cause of
adult blindness, ESRD, non-traumatic lower limb amputations, major contributing factor for heart disease and CVA
type 1: higher rates in Caucasians
type 2: higher rates in non-caucasions
hormone produced in by beta cells in islets of langerhans in pancreas
insulin shifts glucose
from blood into cells
normal blood glucose levels
insulin promotes the storage of
excess glucose to glycogen which is stored in the liver and muscle
once "storage" is filled,
excess glucose converts to free fatty acids (triglycerides)
Type 1 DM
any age, but more common in young.
autoimmune: islet cell autoantibodies
genetic predisposition or exposure to virus, or idiopathic
Type 1 insulin
absent or minimal insulin production
type 1 DM signs/symptoms
polydipsia, polyphasic, polyuria, weight loss, fatigue, increased frequency of infections, rapid onset, insulin dependent, early onset
exogenous insulin in Type I
required by all
Type 2 DM
most prevalent (90%), insidious, gradual onset, family tendency; more prevalent w/ obesity. generally older onset but can occur at any age
Type 2 DM insulin
insulin resistance or delay/ diminished secretion, temporary hyperinsulinemia with hyperglycemia, release of glucose by liver haphazard
Type 2 DM signs and symptoms
fatigue, recurrent infections, visual changes, sedentary lifestyle, familial tendency, average age 50 yrs.
exogenous insulin in type II
required only by some
A cluster of conditions that increase the risk of heart disease, stroke, and diabetes.
conditions related to diabetes
insulin resistance, elevated insulin levels, elevated triglycerides, high LDL, low HDL
Diagnosis of metabolic syndrome
Higher potential for blood clots and increased amount of cholesterol in the blood.
individuals are at an increased risk for developing type 2 diabetes
blood glucose levels are high but not high enough
- FBS 100-125 mg/dl
- oral glucose tolerance test (OGTT) 140-199 mg/dl
-Hgb A1C 5.7% - 6.4%
impaired fasting glucose/ tolerance
These have been found to reduce the risk of moving from pre-DM to DM
maintaining a healthy weight, excessing regularly, eating a healthy diet
yearly, testing urine for glucose/ ketones
Client education for health promotion
exercise and good nutrition
Risk factors of DM
genetics; may predispose individuals to type 1 or type 2
viruses can destroy beta cells (type 1)
obesity, inactivity, increased triglycerides (>250), & HTN may all lead to insulin resistance
Nursing Care/ Patient education
daily management to maintain blood glucose levels as near to normal as possible.
Diet for DM
is based on usual food intake balanced w/ insulin & exercise
- eat regular intervals, do not skip meals
- CHO: whole grains, high fiber, veggies, fruits (minimum of 130 g/day)
-Fats 10%: monounsaturated fats: olive/canola/ fish oils
- proteins: 15-20%
- fiber increases CHO metabolism & controls cholesterol
- limit alcohol because alcohol is filtered through the liver and may impair glucose function. Initially making glucose rise and then drop and a rapid pace.
Fats should be limited to
teach patient administration; rotation of sites
action of insulin
facilitates glucose into cells; stimulations conversion of glucose to glycogen; inhibits glycogenolysis; prevents breakdown of fats for energy
insulin action curve
onset, peak, duration
exogenous for all type 1
(1-5 inject. / day): bolus/basal combo
oral agents or exogenous for type 2
often during illness, need sliding scale coverage
direct effect to lowering BS
self-monitoring of blood glucose (SMBG)
a method of capillary blood glucose testing; immediate info about BS levels to adjustments in food/ activity/ insulin
watch patient perform. Also include family members in how to operate pen, and record glucose levels when taking them.
Pt. education w/ self monitored blood glucose
Correct storage of strips in a closed container & kept dry.
Obtaining adequate amount of blood sample when performing test.
Appropriate hand hygiene.
Use fresh lancets & avoid sharing glucose monitoring equipment to avoid infections.
Piercing site should be on sides of fingers, not pads.
Keep a record of SMBG includes time, date, serum glucose level, insulin dose, food intake and other events altering glucose metabolism such as activity level, stress or illness.
insulin pen information
Remove cap and then change the needle cap each time and clean with alcohol pad.
Rapid- acting insulin
onset: 15 min
Peak: 60-90 min
duration 3-4 hours
short acting insulin
Regular (humulin R, novolin R, ReliOn R)
onset: 1/2-1 hour
peak: 2-3 hours
duration 3-6 hours
intermediate- acting insulin
NPH (humulin N, Novolin N, ReliOn N)
onset: 2-4 hours
peak: 4-10 hours
Duration: 10-16 hours
Onset: 1-2 hours
Peak: no pronounced peak
Duration 24+ hours
rapid acting insulin
lispro, aspart, glulisine
Short acting insulin
Regular (Humulin R)
Novolin R, ReliOn R)
Intermediate acting insulin
NPH (Humulin N
Long acting insulin
Onset is less than 15 minutes
Onset is 30-60 minutes
Cannot be mixed with other insulins and has no peak. If it is long acting, leave it alone.
Clear to cloudy
low, fast onset, too little food, too much insulin, excessive exercise
high, gradual onset, too much food, too little insulin, "couch potato", illness, infection, stress: physical illness and emotional
Symptoms of hypoglycemia
low, "cool and clammy, need some candy", shaking, fast heartbeat, sweating, anxious, dizzy, hunger, impaired vision, weakness, fatigue, headache, irritable
symptoms of hyperglycemia
high, "hot and dry, sugar high", extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, nausea
low, test blood sugar if equipment available, if unable for po food/ fluid, 1 mg/ SC glucagon, ingest 15-20 g of simple CHO repeat 15 min, milk, glucose tabs, fruit juice, soda,
eat a light snack in 15-30 min
half a peanut butter or meat sandwich w/ a half a glass of milk
high, test blood sugar if equipment available, per MD orders/ directions, sliding scale insulin, during illness, check urine for ketones
What is DKA?
diabetic ketoacidosis is characterized by fruity odor in the mouth and this usually happens in type 1 diabetics. Usually happens when they are ill. Insulin shuts down, so body tries to use fat as energy instead of glucose as energy. Then ketones go to blood streams and urine, need fluids, insulin, insulin drip. This causes dehydration, excessive thirst, blurred vision, ketones in urine... This can cause death.
teach patient to call their health care provider when
Blood glucose >240
Fever >102 not responding to antipyretics or lasting >12 hours
Illness lasting > 2 days
**Sick day management: SMBG q3h, drink 4oz sugar-free, non-caffeinated liquid q 30 min to prevent dehydration
If not eating, do not take insulin
rebound hyperglycemia that occurs in the response to a rapid decrease in blood glucose during the night
high BS at hs>> BS drops approx 2am>> stored glucose released >> high BS in a.m.
Dawn phenomenon treatment
pre-dawn rise in BS secondary to growth hormone and cortisol levels, (usually during times of growth spurts)
Nursing Considerations: Monitor for GI effects (flatulence, anorexia, nausea, vomiting), Monitor for lactic acidosis, (especially w/ liver & kidney disorder).
Education: Take w/ food to decrease GI effects, Vitamin B12 & Folic acid should be taken as supplements, may be taken during pregnancy for gestational diabetes, never crush or chew.
If pt is going to have an X-ray Procedure involving contrast or surgery, stop Metformin prior. May resume 48 hours after procedure if serum creatine is normal
increases cellular response to insulin by decreasing insulin resistance
promotes release of insulin and decreases secretions of glucagon
delay absorption of carbohydrates from GI tract, considered a starch blocker, take with the 1st bite of each meal
sulfonylureas (ie:diabineses, glyburdie)
stimulate release of insulin from pancreas
hirer pressure in the kidneys from renin-aldosterone (vasoconstriction)
Hx of HTN
inflammatory process= decreased filtration efficiency allowing larger molecules like proteins to pass through,
high blood pressure + inflammation = decreased circulation
too much blood sugar can make neurons less/more sensitive to pain. Most common complication affecting 50% of DM patients.
damage to the retina as a complication of uncontrolled diabetes
hyperglycemia damages retinal cells
impaired immune system
Candida overgrowth (yeast infections-fungal)
↑BS affects neurotransmitters in brain
Microvascular secondary to ↑BS which causes thickening of arterioles and capillaries
Retinopathy: need annual dilated eye exam
Nephropathy: leading to renal failure; teach pt to report any change in urine output
Neuropathy: demyelination secondary to hyperglycemia
Autonomic MANY potential problems
Macrovascular: d/t altered lipid metabolism
CAD, CVA, HTN, PVD: monitor/tx HTN
Hyperlipidemia, atherosclerosis: Diet/exercise control
Patient and family teaching guide for DM
Complications impacts an individual's lifestyle
Loss of independence, pain, hospitalizations, polypharmacy, decreased quality of life,....
Activity; menu planning; medication compliance
Annual eye exams (dilated)
Kidney assessment: creatinine, albumin (or protein)
Sick day management
More frequent assessment of BS. May require increase insulin d/t elevated BS associated w/ the stress response. Or decrease in dose r/t impaired oral intake
Inspect feet daily. Wash daily w/ mild soap & warm water
Pat feet dry gently, esp between toes
Wear clean/absorbent socks (cotton/wool). Use powder w/ cornstarch on sweaty feet
Do NOT use commercial remedies for removing calluses/corns. >>>>>Consult podiatrist
Trimmed straight across
Nail care after bathing
Avoid open-toe/heal shoes. Do not go barefoot. Proper fitting shoes.
Do not use hot H2O bottles/heating pads on feet.
Avoid prolonged sitting/standing/crossing legs.
artificial production of insulin; produced outside the body
Type 1 Polly
Often has low blood pressure and may have tachycardia
Average age of 50 years
High blood pressure
Testing for Hgb A1C
The glucose in the body binds to the red blood cells, and blood cells live for 90-12o days. So this test is can be done at any time of day and is unaffected by something that you ate 5 minutes ago.
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