Endocrine Lecture

1
Endocrine Lecture

• Day 2 a

2
SS of Hyperglycemia

• Neuro
• Fatigue
• C/O headache
• Dull senses
• Stupor
• Drowsy
• Loss of Consciousness
• Blurred Vision

3
SS of Hyperglycemia

• Cardiovascular
• Tachycardia
• Decreased BP
• (Dehydration)
• Respirations
• Kussmaul's respirations
• Sweet and fruity breath
• Acetone breath

4
SS of Hyperglycemia

• Gastro-intestinal
• Polyphagia
• (Decreased hunger in late stages)
• N/V
• Abd. Pain
• Polydipsia
• Dehydration

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SS of Hyperglycemia

• Genital-urinary
• Polyuria
• Nocturia
• Glycosuria
• Skeletal-muscular
• Weak
• Uncoordinated

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SS of Hyperglycemia

• Integumentary
• Dry skin
• Flushed face
• Hypothermia

7
Small Group Questions

• Mr. McMillan is a 50 year old client brought into
  the ER with extreme fatigue and dehydration.
  After the MD sees him the nurses asks Mr.
  McMillan some additional questions. Based on the
  clients answers the nurse requests that the MD
  add a glucose level to the lab work. The results
  are 800mg/dL.

8
Small group questions

• What question did the nurse most likely ask?
• Why was Mr. McMillan fatigued?
• Why was he dehydrated?

9
Medical Management of DM

• No cure
• Goal is Control! And prevent complications
• Individualized treatment plans
• Diet
• Exercise
• Meds

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Surgical management of DM

• Can we do a pancreas transplant?
• YES!
• Not usually done
• Islet cell transplants

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Dietary management of DMFoundation of Diabetic
control

• Goals
• Maintain near-normal blood glucose levels
• Achieve optimal serum lipid levels
• Provide adequate calories for reasonable weight
• Prevent treat acute complications of
  insulin-treated diabetes
• Improve overall health through optimal nutrition

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R.D.

• Registered dietitian

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The exchange system

• Six categories
• Bread/starch
• Meat
• Milk
• Vegetable
• Fruit
• Fat

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General guidelines of Dietary Management

• Protein
• 20
• Fat
• 20
• Carbohydrates
• 60
• ADA American Diabetic Association

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NCLEX test question

• In teaching the newly diagnosed diabetic about
  the exchange system, the nurse explains that
  potatoes would be considered
• a vegetable exchange.
• a meat exchange.
• a starch-bread exchange.
• a fruit exchange.

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Diabetic Meal Plan

• Small frequent meals
• CONSISTENCY!
• Amount of calories
• Amount of carbohydrates
• Time
• Snacks

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Diabetic Meal Plan

• If the pt is obese, the key to treatment is
• Weight los!

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Sweeteners

• Nutritive sweeteners
• Not calorie free
• Cause less h in BS (than regular sugar)
• Sorbitol ? laxative effect
• Non-nutritive sweeteners
• Minimal or no calories
• Do not h BS

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Meal Plan considerations

• Food preferences
• Lifestyle
• Schedule
• Ethnic / Cultural background

20
Alcohol and Diabetes

• Increase risk of
• Hypoglycemia
• Affects the liver
• Dont take on empty stomach
• Esp. if on insulin or oral hypoglycemic meds
• Moderation

21
NCLEX Question

• A client is noncompliant about adhering to
  dietary restrictions designed to manage his
  diabetes. Which statement by the nurse would be
  most likely to motivate the client to comply with
  treatment?
• I dont understand why you dont follow your
  diet.
• I understand that following this diet is hard
  for you. Care you share with me why this has
  been difficult.
• Not following your diet may shorten you life.
• Let me review your diet with you again, because
  you dont seem to understand it.

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Exercise and Diabetes

• i blood glucose levels
• h the uptake of glucose by body muscle
• Potentates the action of insulin
• i insulin requirement
• Effect lasts 24 hours

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More Benefits of exercise

• Increases circulation
• Improve serum lipid levels
• Improves cardiovascular status
• Assist with wt control
• Decreases stress

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Rules for the exercising diabetic

• Talk to MD first
• Regular vs. sporadic
• Correlate exercise and glucose levels
• Dont exercise when hypoglycemic
• Dont exercise when hyperglycemic gt250

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Rules for the exercising diabetic

• Do not exercise when insulin is peaking
• Carry a quick source of sugar
• Best time 60-90 minutes after a meal

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Rules for the exercising diabetic

• Proper footwear
• May need a pre-exercise snack
• Consistency!

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Monitoring Glucose

• Self-monitoring SMBG
• Glucometers
• Urine testing for glucose
• Have to have skills!
• 2-4 times a day
• Continuous glucose monitory system

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Monitoring Ketone levels

• Dipstick method
• Perform when
• Glucosuria
• Unexplained elevated glucose level
• Illness
• Pregnancy

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Small Group Questions

1. Why are pancreas transplants uncommon?
2. Give signs symptoms of hyperglycemia by body
   system
3. A diabetic meal plans main goal is to maintain
   near normal glucose levels. How is this done?
4. The exchange diabetic meal plan is divided into
   six categories, what are they?

30
Small Group Questions

1. What affect does alcohol have on a diabetic?
2. What affect does exercise have on a diabetic?
3. What council would you give a diabetic regarding
   exercise?