DM 1
3 P's - polyuria, polyphagia, polydipsia
Still produce insulin but have reduced insulin sensitivity or decreased insulin production.
Why might a hospitalized diabetic patient require more insulin than normal?
The body is under stress when sick or injured causing a release of glucose in response to stress hormones, and increased metabolic processes.
What is the blood glucose level for hypoglycemia? What can cause this?
Blood glucose <70.
Too much oral antidiabetic agent or insulin, too little food, too much physical activity.
What is the number 1 priority in treatment of DKA?
Rehydration with an isotonic solution. Adequate tissue & organ perfusion increases glucose excretion by the kidneys, lowering blood glucose level.
Name 5 symptoms of Hypoglycemia
Irritability, headache, excessive hunger, dizziness, shaking or trembling, tachycardia, sweating, confusion or difficulty concentrating
You are caring for a type 2 DM patient who states they feel lightheaded. They last ate 3 hours ago. What intervention is most appropriate?
Check BG via fingerstick, pt could be hypoglycemic.
What is a good diagnostic tool for evaluating the therapeutic management of a diabetic patient? What range do we want it in?
Gylcosylated Hemoglobin aka Hemoglobin A1C. Measures glucose control over 3 months. Goal <7% for a diabetic patient.
List 3 interventions for proper diabetic foot care.
Inspect feet daily, smooth/soften calluses, wear flat shoes, no lotion between toes, cut nails straight across, have yearly podiatry visits.
Name 3 symptoms of a patient in DKA
Confusion, Disorientation, Thirst, dehydration, Kussmaul respirations. (Very deep breaths with a fruity odor from the ketones)
Describe the pathophysiology of type 1 diabetes.
Combo of genetic, immunologic & environmental factors. Destruction of the pancreatic beta cells decreasing or eliminating all insulin production. Creation of islet cell antibodies-autoimmune component.
A Type 2 DM patient is preparing for surgery. What education will be needed?
Do not take insulin/oral anti-diabetic agents the day of surgery. Maintain NPO status. Continue to check blood glucose levels.
Which medication has to be held for 48 hours prior to a scan with contrast dye?
Metformin - Biguanide class - decreases liver glucose production & improves cellular sensitivity to insulin to be able to use it better.
What is the best way to prevent diabetes associated complications
Meticulous blood glucose control!
What type of insulin will be administered the patient in DKA and by which method?
Regular insulin by continuous infusion until a range of 250-300 is achieved, then subcutaneous injections can be given.
The Type 1 patient is at home ill with a viral infection. What 3 pieces of nursing education might the clinic nurse provide?
Never skip insulin, Check BG every 3-4 hours, consume fluids every hour (without added sugar), monitor for signs of DKA (ketones), notify MD if vomiting, diarrhea, or unable to take fluids.
Patient's blood glucose level is 68 and they feel lightheaded. What intervention would you provide?
Give juice (orange or apple) and recheck glucose in 15 minutes. If not elevated in 15 min, repeat juice and recheck in 15 min. Once elevated, give complex carb (milk/graham cracker) and evaluate cause of hypoglycemia.
What is a first step tool a nutrition counselor may offer a newly diagnosed patient to begin learning portion control?
MyPlate
What are macro/microvascular complications?
Long-term side effects from diabetes disease process. Macro - heart (MI), brain (stroke), limbs (neuropathy). Micro - eyes (retinopathy), kidneys (nephropathy).
What are some nursing intervention for a patient in DKA?
Safety, glucose management, monitor hydration status (& for fluid overload!), hourly BG checks
A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, and diaphoresis. What is a priority action?
Check BG and administer glucagon 1mg IM or SQ.
If IV access, 50% Dextrose in Water can be administered.
When might a patient need to check their glucose levels- name 4 incidences
Prior to administering insulin, prior to meals, if they feel 'low'- hypoglycemic, if they feel 'high'- hyperglycemic, before exercising, before bed, wen they are sick.
Which ORAL antidiabetic drug MUST be taken with food at the FIRST meal of the day?
Gliburide/Glipizide/Glymepiride - Second gen sulfonylureas - stimulates the pancreatic beta cells to produce insulin. Avoid with patients who have a sulfa allergy.
Name 4 of complications resulting from uncontrolled diabetes.
DKA, HHS, poorly-healing wounds, macro/micro vascular complications.
What may be a precipitating cause of DKA
Missing insulin doses, stress, illness