Diabetes mellitus
Type 1 diabetes
Insulin dependent
Usually rapid onset
Normally seen in younger individuals
Use
Treatment in type 1 and 2 diabetes
Adjunct therapy for type 2
Used for periods of high stress, sick days
Sulfonylureas
Improve insulin release from pancreas
Adjunct to diet and exercise
ONLY FOR TYPE 2
1st gen- chlorpropamide
2nd gen- glipizide, glyburide
Action
Raise blood glucose levels when severe hypoglycemia occurs
Type 2
Non insulin dependent
Usually in mature adults
Slow and progressive onset
Can be controlled with diet and exercise
AE of insulin
Injection site irritationn
Biguanides (metformin)
Improve insulin release from pancreas
Adjunct to diet/exercise
1st choice for type 2 diabetes
Complications- GI effects, Folic Acid deficiency.
LACTIC ACIDOSIS - HIGH MORTALITY RATE
DO NOT COMBINE WITH IV CONTRAST
Prototypes
Diazoxide
Client education Lowering BG
Insulin
Exercise
Diet
Lack of intake
Oral Antidiabetics
Nursing considerations for insulin
Lifestyle changes - diet and exercise
Rotate vial, avoid shaking
Monitor BG levels
Monitor for S/S of hypoglycemia
Double check med/dose with second nurse
Monitor food intake/ exervise
Monitor sensory loss and implement safety measures
Other antidiabetic agents
Rosiglitazone - can cause fluid retention, Hepatoxicity, increased LDL
Acarbose, miglitol - Slow carb absorption, effective for latino and African heritage
Nursing considerations
Monitor BG levels carefully
Have insulin on standby
Monitor nutritional status
Alert provider
Make changes to diet
Insulin and oral antidiabetics
Client education raise BG
Glucagon
Food
Sugar
Illness, Stress
Lack of sleep
D50W
TPN
Insulin types
Rapid acting- Lispro, given within 15 min of meals
Short acting- regular, given within 30 min
Intermediate Acting- NPH, give within 2-4H
Very Long- Glargine, given at bedime to lower overall BG for 1-6 H
Rapid acting Inhaled-
Considerations for ORAL antidiabetics
Admin appropriately with meals
BG monitoring
Ensure diet exercise modification and nutrition monitoring
Monitor Liver/Kidney function
Cool and clammy give them candy(hypoglycemic)
Glucose
Glucagon
D50W
1 is rapid onset
seen in younger
insulin dependent
2 is slow and progressive
seen in older
non insulin dependent
Injection sites
Abdomen
Posterior upper arm
Anterior upper arm
Thigh
Hypoglycemia
Occurs with starvation
Lowering of blood sugar to far with insulin/oral antidiabetics
May be associated with pancreatic disorders, cancer, kidney disease, anterior pituitary disorders
Hyperglycemia treatment
Hot & dry sugar high
Insulin