TYPE 1
What are the classic signs of type 1 DM?
Polyuria (frequent urination)
Polydipsia (excessive thirst)
Polyphagia (excessive hunger)
Weight loss, Weakness, Fatigue, ketoacidosis
¨Nonspecific symptoms
Classic symptoms of type 1 may manifest
¨Fatigue
¨Recurrent infection
¨Recurrent vaginal yeast or candida infection
¨Prolonged wound healing
¨Visual problems
what is a good level for blood glucose?
79-100 is good
____ is a good identifier of long-term glucose levels
A1C, reflects us glucose levels over past 2-3 months
what do you teach pt about self-monitory?
instruct them how to test and use calibrotor meter
when to test:
before meals, 2 hours after first bite, when hypoglycemia is expected , every 4 hours during illness, before and after exercise
what are some nutritional therapy for type 1?
Meal planning
Based on usual food intake and preferences
Balanced with insulin and exercise patterns
Day-to-day consistency makes it easier to manage blood glucose levels
Rapid-acting insulin, multiple daily injections, and insulin pump offer flexibility based on current blood glucose level and carbohydrate content of meal
what is some nutritional therapy for type 2?
Emphasis on achieving glucose, lipid, and BP goal
Moderate weight loss (5% to 7%) improves insulin sensitivity
Nutritionally adequate meal plan appropriate serving sizes and reduced saturated and trans fats and low CHO can decrease calorie
Spacing meals and regular exercise
Effectiveness of therapy monitored by blood glucose levels, A1C, lipids, and BP
(in class she said exercise decreases need for insulin & have consisetant intake of carbs & sugar, protein encouraged only if aqdqute kidney function)
hypoglycemia manifestations?
Blood glucose < 70 mg/dL
Cold, clammy skin
Numbness fingers, toes, mouth
Tachycardia
Emotional changes
Headache
Nervousness, tremors
Faintness, dizziness
Unsteady gait, slurred speech
Hunger
Vision changes
Seizures, coma
long-acting insulin has ____
no peak and last longest
what are some objective nursing assessments?
Possible diagnostic findings
Increased triglycerides, cholesterol, LDL, VLDL
Decreased HDLHemoglobin A1C value > 6.0%
Glycosuria
Ketonuria
Albuminuria
Acidosis
what are some type 1 facts?
- more common in younger people but can occur at at any age
-signs and symptoms usually abrubt but disease may be present for several years
-accounts for 5-10% of all types of diabetes
-endongenous insulin is absent
- environmental factors are virus and toxins
-primary defect is absent or minimal insulin production
-keotiosis is present at oneset or during insulin deficiency
-insluin therapy is always required
-nutritonal status is thin,normal or obsese
-vascular and neuroglic complications frequnt
what are some type 2 facts?
-more common in adults but can occur at any age, incidence increasing in children
-gradually may go undiagnosed for years
-accounts for 90%-95% of all types of diabetes
-endongenous insulin is initially increased in response to insulin resistance. secretion decreases over time
-enviromental factors are obesity and lack of exercise
-primary defect is Insulin resistance, decreased insulin production over time, and changes in adipokines production
-symptoms:Often none. Fatigue, recurrent infections. May also have polyuria, polydipsia, and polyphagia
-ketosis:Not present except during infection or stress
-insulin therapy:Required for some. Disease is progressive and insulin treatment may need to be added to treatment plan
-nutritional status: often obese or overweight but may be normal
-vascular and neurlogic complications are frequent
causes of hypoglycemia
Alcohol intake without food
Too little food
Too much diabetes meds
Too much exercise without food
Diabetes med or food at wrong time
Loss of weight without med adjustment
Use of b-adrenergic blockers interfering with symptoms
what is a high dose of insulin resulting in decreased glucose levels during the night?
Somogyi effect
you check for this by checking glucose between 2-4 am
assess pt for HA,night sweats, or nightmares
Maintain normal diet if able
Increase noncaloric fluids
Continue taking diabetic medications
If eating less than normal, supplement with CHO− containing fluids while continuing medications
If unable to eat or drink, contact HC
what is DKA, causes, and S&S?
Diabetic ketoacidosis only in type 1
patho:no insulin, no sugar in cell (burn fat as fuel which = ketones), faster onset and easier to fix usually in younger pt
Causes: Sepsis(infection) sickness, stress, skip insulin
S&S: kussmual resp, keytons, metabolic acidosis (pH 7.35 or less) fruity breath, abdominal pain, dry and high sugar 250-500
What is HHNS/HHS, causes and S&S
Hyperglycemic hyperosmolar non-ketotic syndrome
typer 2 only
Patho: few insulin, puts sugar into cell (no ketones), slower onset,older age, harder to fix
S&S: HA, confusion, sugar over 600, higher fluid loss extreme dehydration, slower onset and stable K, no acid
what is given for hypogylcemia or first aid for hypoglycemia?
glucogen is given to uncousicous person either thru SQ IM or IV(preferred)
reconstiuted from powder only give if solution is clear
watch for N/V and hyperglycemia, toxic effect can be hypokalemia
what is morning hyperglycemia present on awakening?
dawn phenomenon
May be due to release of counterregulatory hormones in predawn hours (more common in adolescence and younger adults)
what are some personal care nursing implementations for amblumentary care?
Personal hygiene
Regular oral care and dental visits
Regular bathing and foot care
Inspect daily
Avoid going barefoot
Proper footwear
How to treat and monitor wounds; when to report to HCP
Treatment for DKA?
treat hydration first with 0.9% normal saline, hourly BS check, kill sugar slowly, if BS over 250 give IV, regular insulin only, if BS below 200 or ketones resolve give SQ plus D50 IV bc smooth sugar tranitioning add K to iv also
HHNS treatment?
hydration first 0.9% saline, stabilize sugars slowly with insulin and check BS
hyperglycemia manifestations?
¡Elevated blood glucose
¡Increased urination
¡Increased appetite followed by lack of appetite
¡Weakness, fatigue
¡Blurred vision
¡Headache
Glycosuria
Nausea and vomiting
Abdominal cramps
Progression to DKA or HHS
Mood swings
tip to tell pt while exercising?
bring a fast-acting source of carbohydrates, risk to cause hypoglycemia
what are some nursing managment evulations ?
State key elements of the treatment plan
Describe self-care measures that may prevent or slow progression of chronic complications
Maintain a balance of nutrition, activity, and insulin availability that results in stable, safe, and healthy blood glucose levels
Have no injury from decreased sensation in the feet
Implement measures to increase peripheral circulation
Have them notify HCP if changes in urinary pattern