Nutrition
This nutrient is responsible for the rebuilding and replacing body tissues.
Protein!
Plays a role in hormone production, fluid balance, antibody production, and transportation of nutrients
Supplies approximately 4 calories/g
Composed of amino acids
◦9 essential ◦11 nonessential
To maintain optimum nutrition, from which type of nutrient should a diabetic patient obtain the majority of his or her calories?
Carbohydrates
It is generally recommended that the diabetic patient consume 1500 to 2000 calories daily, with 45% to 65% of the calories from carbohydrates, 10% to 35% from protein, and 20% to 35% from fat.
Complications that arise from Diabetes include:
(Name at least 2)
Hypertension, atherosclerosis (leading to MI), retinopathy, renal disease, peripheral vascular disease (non healing ulcer, loss of limb), neuropathy (sexual dysfunction, bladder incontinence, paresthesia, gastroparesis), periodontal disease with loss of teeth.
True or False:
Nutrient needs decrease in adults as they age.
False, nutrient needs remain the same, as caloric needs decrease each decade after 50.
Changes in taste and smell decrease appetite. Eating alone is unpleasant and deters older adults from eating adequately. Memory issues can impact proper nutrition also.
Subcutaneous
Insulin may be administered in the fatty tissue of the abdomen, buttocks, back of arm, and front of thighs. It is important to rotate sites frequently to promote optimal absorption of the medication.
This lab value is often utilized when assessing for malnutrition in a patient?
Prealbumin.
Prealbumin assessment is preferred because it decreases more quickly when nutrition is inadequate. Albumin is a major serum protein that is below normal in patients who have had inadequate nutrition for weeks.
These are the times that patients with diabetes should check their capillary blood glucose (CBG/FSBS).
Patient should check blood glucose level before each meal and at bedtime
Insulin is secreted here.
Insulin is secreted by beta cells in the islets of Langerhans in the pancreas.
During this time for adolescents, the body requires more nutrients such as B vitamins, calcium, and iron.
Growth spurt.
Calcium & Vit D for bone growth. Teen girls also require more iron after menstrual cycle begins. Encourage snacks high in calcium, iron, and protein. Avoid fast food when possible. Provide milk and sparkling water in place of sodas.
Over the counter decongestants for the common cold can (increase/have no effect on/decrease) blood sugar levels.
Increase
Medications like pseudoephedrine (Sudafed) and oxymetazoline (Afrin) can increase blood sugar levels.
Name all the constituents of the USDA MyPlate.
Fruits, vegetables, grains, protein, & dairy.
Vegetables 40%, Grains 30%, Protein 20%, Fruit 10%, Dairy is the smallest portion, and is denoted by a small circle.
This is considered an important part of diabetes management, and improves blood glucose levels by "burning up" extra glucose.
Exercise.
Exercise makes insulin receptors on cells more sensitive and improves cellular uptake of available glucose.
90-95% of people diagnosed with diabetes have this type.
DM II.
Type 1 Caused by autoimmune destruction of the beta cells in the pancreas; no insulin secretion from pancreas. Generally early age of onset. Symptoms: Polydipsia, polyphagia, polyuria Weight loss
Type II - Decreased beta cell production & insulin resistance.
This alteration in nutrition is becoming increasingly more prevalent among school aged children.
Obesity.
An excessive accumulation of body fat characterized by a BMI of 30 or greater. Parents should serve as role models and also provide a nutritious breakfast to start the day. Provide after school snacks such as fruit and veggies and avoid high fat snacks.
Lispro (Humalog) is typically given before ______ and glargine (Lantus) is typically given _______.
Insulin lispro is given before meals and insulin glargine is give before bedtime.
Lispro is a rapid acting insulin with onset 15 minutes, peak 1-3 hrs, and duration 3-5hrs. Glargine is long acting insulin which mimics basal insulin with onset 1 hr, peak unknown, duration 24 hrs.
There are many common risk factors for inadequate nutrition. Name three (3).
Genetics, stress, depression/social isolation, fad diets (not enough nutrients), obesity, substance abuse, lack of money (food insecurity), impaired food intake (dysphagia, poor appetite, poor oral health), thyroid disorder, chronic disease (COPD, cancer, etc), GI distress (N/V/D), anorexia/bulimia.
Older adults at the largest risk due to chronic disease, poor oral health, and social isolation.
Having a BMI greater than this, greatly increases predisposition to developing type II diabetes.
25
Being overweight (BMI of 25-29.9), or affected by obesity (BMI of 30-39.9) or morbid obesity (BMI of 40 or greater), greatly increases your risk of developing type 2 diabetes. The more excess weight you have, the more resistant your muscle and tissue cells become to your own insulin hormone.
The method of diagnosing diabetes when blood sugar levels are assessed after fasting all night.
Fasting blood sugar test.
Expected fasting blood sugar is 70-100mg/dL. Prediabetes = 100-126mg/dL. A positive diabetes diagnosis is 126mg/dL or greater on two separate readings.
Name two methods to promote optimal nutrition in toddlers.
Avoid combo foods, provide appropriate sized utensils, use fun plates and dishes, include finger foods, provide colorful choices, avoid forcing toddlers to eat, offer easy to chew/eat foods, provide small servings.
The risk of hypoglycemia is greatest with long acting or short acting insulin.
Short acting insulin like lispro.
Hypoglycemia is more likely with short-acting insulin because it can increase the risk of taking too much insulin, which can lead to dangerously low blood sugar levels
When educating patients on healthy diets, in addition to incorporating MyPlate guidelines, patients should be taught to avoid foods high in this?
Fat and sodium.
Meals can be made healthier by teaching patients to prepare food with less fat and sodium. Use of herbal, low sodium seasoning can be utilized to maintain flavor.
It is essential for the nurse to teach the patient with diabetes to frequently inspect this.
Feet/Lower Extremities.
60-70% of people with DM have neuropathy. Neuropathy affects the peripheral nerves. Because the patient usually cannot feel cuts, blisters, or abrasions on the foot, there is great danger that a sore may become infected. There is potential for serious injury without awareness.
A patient is sick and doesn't want to eat or drink anything. They ask you, the nurse, if they should take their insulin. What is the appropriate response.
Take insulin as prescribed, even on sick days.
Illness can make it harder to manage blood sugar levels. When you're sick, your body releases hormones to fight the illness, which can raise your blood sugar levels. Your liver also makes glucose and releases it into your blood, even when you're not eating as much as usual.
These problems in adulthood can be attributed to stress, poor eating, and lack of exercise.
Obesity and hypertension.
Lifestyle recommendations include: decrease fat and sodium intake, decrease intake of simple sugars, increase fresh fruits, veggies, and whole grains, prepare more meals at home, and increase activity levels.
The goal of insulin therapy is to closely mimic this.
Basal insulin.
Basal insulin is the amount of insulin that would be produced by the pancreas throughout the day to maintain healthy blood sugar levels both between meals and postprandial (after meals).