Diabetes Concept Seminar 7

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Diabetes Concept Seminar 7

• Nursing 1901
• Fall, 2005
• Carol Isaac MacKusick, MSN, RN, CNN

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Diabetes Mellitus

• Group of metabolic diseases
• 4 main types
• 1, 2, gestational, other syndromes
• Costly
• High Prevalence

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Risk Factors

• Family history
• Obesity
• Race / ethnicity
• Insulin resistance or metabolic syndrome
• Hypertension
• Abnormal lipids
• Hx gestational DM, or delivery of babies gt 9
  pounds

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Some basic concepts

• Figure 41-1 patho
• Know table 41-1 classification
• Chart 41-2, 41-3 prevention, diagnosis
• Chart 41-1 assessment

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Diabetes Management

• Five components
• Nutritional
• Exercise
• Monitoring
• Pharmacology
• Education

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Nutritional Management

• Adequate caloric needs
• Especially important in children, adolescents
• Appropriate ratio of CHO fats proteins
• Food exchanges versus CHO counting
• ETOH consumption
• Sweeteners
• Fiber
• Food labels

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Exercise

• Increases CHO metabolism
• Precautions
• BS gt 250 check ketones
• 1 appropriate blood sugar
• Insulin needs vary
• Snack usually required beforehand
• 2 generally doesnt require extra food
• Clearance from MD or CDE

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Monitoring

• Blood glucose
• Frequency
• Responding to results
• Finger stick
• Alternative site stick
• Watch
• Ketones
• Control deteriorating (type 1)

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Monitoring

• Glycosylated Hemoglobin
• Normal 4 - 6
• Equates to average daily blood glucose of 80-110
• HgA1c

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Pharmacological Management

• Insulin
• Know table 41-3
• Clear before cloudy
• In Hospital, 2 RN verification
• Sliding scale / hospitalization
• Other protocols
• Teach one use / syringe
• Complications
• Generally related to administration issues

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Pharmacological Management

• Insulin regimens
• Table 41-4
• Insulin resistance
• Hyper / hypoglycemia
• Pens, pumps
• Inhaled insulin
• Insulin starting points 0.5 1 unit / kg of
  body weight

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Oral Antidiabetic Agents

• Table 41-6
• Combination therapy
• Use in PCOS / metabolic syndrome / syndrome X
• I dont have real diabetes

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Education

• Chronic illness
• Psycho social counseling may be needed
• Progressive education
• Team approach
• Family teaching
• Survival skills first
• Continuing ed later

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Education

• Insulin waning
• Dawn phenomenon
• Somagyi effect
• Sick day rules
• Hypo / hyperglycemia and treatment
• How to reach team
• How to get supplies
• Diet / exercise info

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Education

• Later education focuses on reduction of
  complications
• Feet
• Eyes
• Hygiene
• Heart disease
• Kidneys
• Travel tips

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Self Administration of Insulin

• Misconceptions table 41-7
• Storage
• Selection of syringe
• Calculation
• Mixing of insulins
• Withdrawing of insulin
• Selection of sites

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Self Administration of Insulin

• Preparing the skin
• Needle insertion
• Disposal of sharps
• Outcome criteria chart 41-8

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Acute Complications

• Hypoglycemia
• 15/15
• glucagon
• DKA
• Type 1
• HHNS
• Type 2
• Table 41-8
• Compare and contrast DKA / HHNS

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Potential Nursing Diagnosis

• FVD
• Altered nutrition
• Knowledge deficit
• Self care deficit
• Anxiety
• FVO
• Altered sensorium

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Evaluation / Outcomes

• Fluid and electrolyte status WNL
• Metabolic balance
• Verbalizes survival skills
• Describes treatment modalities
• Demonstrates appropriate self administration
• Verbalizes nutritional plan
• Demonstrates SMBG

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Evaluation / Outcomes

• Knows resources
• Identifies acute complications
• Identifies treatment for hypoglycemia
• Wears medical identification
• Verbalizes sx hyperglycemia
• Verbalizes understanding of sick day management

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Surgical Considerations

• NPO status
• IV insulin during surgery
• Cortisol / stress
• Sliding scale insulin
• BS-100 / 30 units of regular
• Type 2 demands

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Questions??
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Your Turn!!

• With the information provided, divide into groups
• We will share information at the end when time is
  called