Nursing Management Diabetes Mellitus

Age at onset or type 1 and 2 diabetes
Age at onset
Type 1= More common in young persons but can occur at any age.
Type 2= Usually age 35 yr or older but can occur at any age
Incidence is increasing in children
Primary defectt of type 1 and 2 Diabetes
Type 1= Absent or minimal insulin production
Type 2 =Insulin resistance, decreased insulin production over time, and alterations in production of adipokines.
Symptoms of type 1 and 2 diabetes
Type 1= Thirst, polyuria, polyphagia, fatigue, weight loss
Type 2= Frequently none, fatigue, recurrent infections
A1C
≥6.5%
Fasting plasma glucose (FPG) level
≥126 mg/dL
Fasting is defined as
no caloric intake for at least 8 hours.
Two-hour plasma glucose level
≥200 mg/dL
A confirmation of diabetes In a patient with classic symptoms of hyperglycemia (polyuria, polydipsia, unexplained weight loss) or hyperglycemic crisis, a random plasma glucose is?
≥200 mg/dL
IGT ( impaired glucose tolerance) is classified as a 2-hour plasma glucose level higher than normal but lower than that considered diagnostic for diabetes mellitus (between?
between 140 and 199 mg/dL
Impaired fasting glucose (IFG)
100 mg/dL but less than 126 mg/dL
Rapid-acting insulin
ispro (Humalog)
aspart (NovoLog)
glulisine (Apidra)
Starts to work in 15 min
Short-acting insulin
regular (Humulin R, Novolin R, ReliOn R)
Starts working in 30-60min
Long-acting insulin
glargine (Lantus)
detemir (Levemir)
Cannot be mixed and should be given at the same time every day.
The treatment for the Somogyi effect is
less insulin
The treatment for dawn phenomenon is
an adjustment in the timing of insulin administration or an increase in insulin. Pt’s blood sugar should be tested between 2-4am.
OAs work on the three defects of type 2 diabetes:
(1) insulin resistance, (2) decreased insulin production, and (3) increased hepatic glucose production.
Sulfonylureas include what three drugs
(Glucotrol, Glucotrol XL), glyburide (Micronase, DiaBeta, Glynase), and glimepiride (Amaryl).
The primary action of the sulfonylureas is to?
What is the major side affect of sulfonylureas?
The primary action of the sulfonylureas is to increase insulin production from the pancreas. Therefore hypoglycemia is the major side effect with sulfonylureas. They also can cause weight gain.
Meglitinides Name 2
repaglinide (Prandin) and nateglinide (Starlix)
The primary action of Meglitinides is to?
Do Meglitinides cause hypoglycemia?
When can they be taken?
Can they be taken if a meal is skipped?
The primary action of the Meglitinides is to increase insulin production from the pancreas. Unlike Sulfonylureas Meglitinides do not cause hypoglycemia and can be taken (30min or right before a meal) but they also cause weight gain.
They should not be taken when a meal is skipped.
The primary action of Biguanides
The primary action of metformin is to reduce glucose production by the liver. It also enhances insulin sensitivity at the tissue level and improves glucose transport into the cells.
Name one Biguanides
Metformin (Glucophage)
When are Biguanides prescribed
The can be prescribed for individuals with prediabetes and those who are obese because they do not cause weight gain and patients who have been diagnosed with hypertension and who are under 60.
What precautions must be taken when Biguanides are prescribed.
Do not use in patients with kidney disease, liver disease, or heart failure.
• Do not use in people who drink excessive amounts of alcohol.
α-Glucosidase Inhibitors (Name 2)
Acarbose (Precose) and miglitol (Glyset)
What part of the body do α-Glucosidase work on and what do they do?
“starch blockers,” these drugs work by slowing down the absorption of carbohydrate in the small intestine.
When are α-Glucosidase Inhibitors taken?
Taken with the first bite of each main meal, they are most effective in lowering postprandial blood glucose
Name 2 Thiazolidinediones
pioglitazone (Actos) and rosiglitazone (Avandia)
What do Thiazolidinediones do for patients?
They improve insulin sensitivity, transport, and utilization at target tissues.
Do Thiazolidinediones increase insulin production?
Can they cause hypoglycemia?
What other problem can Thiazolidinediones cause.
Because they do not increase insulin production, thiazolidinediones will not cause hypoglycemia when used alone, but the risk is still present when a thiazolidinedione is used in combination with a sulfonylurea or insulin.
They can also cause fluid retention.
When should Rosiglitazone (Avandia) not be used?
• Increased risk of myocardial infarction and stroke.
• Do not use in patients with heart failure.
What is the minimum level or carbohydrates that should be consumed by diabetics.
What amount of fiber should be consumed daily?
Minimum of 130 g/day.
Fiber intake at 14 g/1000 kcal
What percentage of proteins should be consumed daily.
15%-20% of total calories.
• High-protein diets are not recommended for weight loss.
What amount of saturated fat and cholesterol should be consumed daily?
Limit saturated fat to <7% of total calories. • Trans fat should be minimized. • Dietary cholesterol <200 mg/day. • ≥2 servings of fish per week to provide polyunsaturated fatty acids.
LIGHT ACTIVITY
Driving a car
Fishing
Light housework
Secretarial work
Teaching
Walking casually
MODERATE ACTIVITY
Active housework
Bicycling (light)
Bowling
Dancing
Gardening
Golf
Roller skating
Walking briskly
VIGOROUS ACTIVITY
Aerobic exercise
Bicycling (vigorous)
Hard labor
Ice skating
Outdoor sports
Running
Soccer
Tennis
Wood chopping