Upgrade to remove ads
Med Surg Chapt 41: Diabetes Mellitus
Assessment and Management of Patients with Diabetes Mellitus
Terms in this set (35)
disease characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both; accompanied by pancreatic disease, hormonal abnormalities, corticosteroids, estrogen preparations; minority populations and elderly most affected
type 1 diabetes
metabolic disorder, absence of insulin production and secretion; beta cells (produce insulin) are destroyed by autoimmune process; pt requires insulin (little or non produced); onset acute and before 30 yo; pt thin at diagnosis; formerly called insulin-dependent, juvenile.
type 2 diabetes
insulin resistance and impaired beta cell function = deficiency of insulin production, decreased insulin action, increased insulin resistance; 90-95% of ppl with diabetes; common in >30 yo and obese; slow, progressive glucose intolerance; first treated with diet and exercise; oral hypoglycemic agents and insulin used; leading cause of blindness (retinopathy), chronic renal failure; pt obese at diagnosis; formerly called non-insulin-dependent, adult-onset.
type 1 risk factors
not inherited; a genetic predisposition combined with immunologic and possibly environmental (viral) factors
type 2 risk factors
family history of diabetes, obesity, race/ethnicity, age > 45 yo, previous identified impaired fasting glucose or impaired glucose tolerance, hypertension ≥ 140/90, HDL ≤ 35 and/or triglycerides ≥ 250, history of gestational diabetes or babies over 9 pounds
Three Ps: Polyuria (increase urination), Polydypsia (increase thirst), Polyphagia (wt loss despite food intake)
Fatigue, weakness, vision changes, neuropathies in hands or feet, dry skin, skin lesions or slow healing wounds, recurrent infections; Type 1 may have sudden weight loss, nausea, vomiting, and abdominal pain if DKA has developed
low blood glucose level < 50-60 mg/dL; d/t too much insulin or oral hypoglycemic agents, too little food, and excessive physical activity
elevated blood glucose level; fasting level > than 110 mg/dL, random > 200 mg/dL
A1C (Hgb A1c)
long term measure of glucose control over the life of the RBC (120 days). Value should be <7% in diabetic pts.
function of insulin
secreted by beta cells of the islets of Langerhans, lowers the blood glucose level after meals by facilitating the uptake and utilization of glucose by muscle, fat, liver cells.
type 1: exogenous insulin admin for life
type 2: insulin may be needed if meal planning and oral agents are ineffective
rapid acting insulin
short acting insulin
Regular (Humalog R, Novolin R, Iletin II Regular). Adm 20-30 min before a meal; may be taken alone or in combination with longer acting insulin
NPH (neutral protamine Hagedorn); usually taken after food
very long acting
glargine (Lantus), Detemir (Levemir); used for basal dose
describes how much food increases blood glucose; starchy food with protein and fat slows absorption, and glycemic response; Raw/whole foods have lower response than cooked/chopped/pureed foods; whole fruits rather than juices, decreases glycemic response due to fiber-slowing absorption; Adding food with sugars may produce lower response if eaten with foods that are more slowly absorbed
alcohol: intake on an empty stomach can lead to hypoglycemia, moderation is key (1/day for women & 2/day for men), incorporate calories from alcohol into meal plan (esp for type 2); sweeteners: nutritive (caloric), nonnutritive (min to no calories) minimal to no elevation in blood glucose levels approved for diabetics; reading labels: "sugarless" or "sugarfree" provide calories and sig sugar or fat
exercise and diabetes
lowers blood sugar (increases uptake of glucose by muscles), aids in wt loss, lowers cardiovascular risk
exercise precautions with diabetes
avoid if elevated blood sugar levels (>250 mg/dL) and ketones in urine; insulin decreases with exercise (pts on exogenous insulin to eat 15g carbs prior to prevent hypoglycemia); adjust insulin if wt loss; monitor for post exercise hypoglycemia
exercise recommendations for diabetes
regular exercise; gradual, slow increase in exercise period is encouraged; modify exercise regimen to pt needs and presence of diabetic complications or potential cardiovascular problems; exercise stress test for patients > 30 who have 2 or more risk factors;
Gerontologic considerations (does not exceed pts physical capacity)
Adrenergic symptoms: sweating, tremors, tachycardia, palpitations, nervousness, hunger
Central nervous system symptoms: inability to concentrate, headache, confusion, memory lapses, slurred speech, numbness of lips and tongue, irrational/combative behavior, double vision, drowsiness
Severe hypoglycemia may cause disorientation, seizures, LOC
Onset is abrupt/unexpected; symptoms vary from person to person, vary related to how rapidly the decrease in blood glucose and the usual blood glucose range
Decreased adrenergic response may affect symptoms in persons who have had diabetes for many years probably related to autonomic neuropathy
Treatment must be immediate; Give 15 g of fast-acting, concentrated carbohydrate: 3 or 4 glucose tablets, 4-6 ounces of juice or regular soda (not diet soda), 6-10 hard candies, 2-3 teaspoons of honey; retest blood glucose in 15 minutes, retreat if >70 mg/dL or if symptoms persist more than 10-15 minutes and testing is not possible.
Provide a snack with protein and carbohydrate unless the patient plans to eat a meal within 30-60 minutes.
hypoglycemia: emergency measures
If the patient cannot swallow or is unconscious:
Subcutaneous or intramuscular glucagon 1 mg
25-50 mL 50% dextrose solution IV
Atavan also given for seizures
diabetic ketoacidosis (DKA)
a metabolic derangement in type 1 diabetes d/t a deficiency of insulin; highly acidic ketone bodies are formed, resulting in acidosis; usually requires hospitalization and caused by non-adherence to insulin regimen, concurrent illness or infection
polyuria, polydipsia, blurred vision, weakness, headache, anorexia, abdominal pain, N/V, hyperventilation with Kussmaul respirations, fruity breath odor, if left untreated: altered LOC, coma, death
Blood glucose levels vary from 300-800 mg/dL; severity is not related to blood glucose level; ketoacidosis is reflected in low serum bicarbonate and low pH; low PCO2 reflects respiratory compensation; ketone bodies in blood and urine; electrolytes vary according to water loss and level of hydration
"sick day rules"; assess for underlying causes;
diagnosis and proper management of diabetes
"sick day rules"
take insulin or oral antidiabetics as usual; test blood glucose and urine ketones q 3 to 4 hrs; report elevated glucose level (>300mg/dL) or urine ketones; if taking insulin, supplemental doses of regular insulin needed q 3 to 4 hrs; substitute soft foods if needed 6 to 8 times/day; takes liquids for V/D and fever and inform health care provider; hospitalization may be required if unable to retain oral fluids to avoid DKA and coma.
Rehydration with IV fluid; IV continuous infusion of regular insulin; reverse acidosis and restore electrolyte balance; Note: rehydration leads to increased plasma volume and decreased K+, insulin enhances the movement of K+ from extracellular fluid into the cells
Monitor: Blood glucose and renal function/UO
EKG and electrolyte levels—Potassium
VS, lung assessments, signs of fluid overload
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
Hyperosmolality and hyperglycemia occur d/t lack of effective insulin; ketosis is minimal or absent.
Hyperglycemia causes osmotic diuresis with loss of water and electrolytes; hypernatremia, and increased osmolality occur; high mortality (more so than DKA).
hypotension, profound dehydration, tachycardia, and variable neurologic signs due to cerebral dehydration.
rehydration; insulin administration; monitor fluid volume and electrolyte status;
Prevention: SBGM (self monitoring blood glucose), diagnosis and management of diabetes; assess and promote self-care management skills
long term complications of diabetes
Macrovascular complications: accelerated atherosclerotic changes, coronary artery disease, cerebrovascular disease, and peripheral vascular disease; Microvascular complications: diabetic retinopathy, nephropathy; Neuropathic changes:
peripheral neuropathy, autonomic neuropathies, hypoglycemic unawareness, neuropathy, sexual dysfunction
teaching diabetic patients self care
Assess knowledge and adherence to plan of care;
provide basic information about diabetes, its cause and symptoms, and acute and chronic complications and their treatment; teach self-care activities to prevent long-term complications including foot care, eye care, and risk-factor management;include family in plan of care;provide information, encourage health promotion activities, and recommended health screenings.
This set is often in folders with...
Med-Surg 2 Exam 1 Cardiac
Med Surg Respiratory
Fluid & Electrolytes
Lab Values & Electrolytes
You might also like...
Chapter 51; Diabetes Mellitus
Other sets by this creator
Pharm Chapt 40: Antiviral Drugs
Pharm Chapt 27: Fluid and Electrolytes
Pharm Chapter 26: Diuretic Drugs
Pharm Chapt 42: Antifungals