Lauren & Drew
Lauren & Drew
Chronic multisystem disease affecting 20% of
U.S. population
6th leading cause of death in the U.S.
Results from dysfunctional glucose transport in
body
The increase of glucose in your blood
stimulates beta cells in the pancreas to
secrete “insulin”
Insulin facilitates glucose transport into cells for
oxidation & energy production
Insulin transports glucose from bloodstream
into cells
There is an impaired glucose transport
because of decreased or absent insulin
secretion and/or ineffective insulin action
Patient can not store glucose in their liver
and muscle as glycogen
Type 1: absolute deficiency of insulin due to
destruction of pancreatic beta cells
If insulin is not given, fats are metabolized,
which can result in Metabolic Acidosis (Diabetic
Ketoacidosis)
Type 2: lack of insulin or resistance to the
action of insulin
Gestational DM
Detected during 24-28 weeks gestation
Neonate: macrosomia, hypoglycemia, hypocalcemia,
and hyperbilirubinemia
Normal glucose 6 weeks postpartum
Secondary DM
Associated with other conditions and syndromes
Cushing’s syndrome and pancreatic disease
Once underlying condition treated, secondary DM
is resolved
Hyperglycemia
Polyuria
Polydipsia
Unintentional weight loss
Polyphagia
Recurrent blurred vision
Weakness/fatigue
Dizziness
Pruritus, skin infections, vaginitis,
Ketonuria
Macro:
Coronary artery disease
Hypertension
Cardiomyopathy
Infection
Micro:
Nephropathy (kidney)
Neuropathy (nerve)
60% of DM pt’s have neuropathy
Retinopathy (eyes)
‘pathy’ – damage or distress to that area
Fasting glucose level of 126mg/dl –OR-
Classic symptoms of DM with casual glucose
reading at 200mg/dl or above –OR-
2-hour postload glucose reading at 200mg/dl
or above during an oral glucose tolerance
test.
Affects 10% of pts with DM
Usually diagnosed before age 30
Inherited as a heterogeneous multigenic trait
Environmental triggers (viruses) trigger an
autoimmune response that destroys the beta
cells
Gradual, subtle, more slowly developing disease
Affects 90% of all people with diabetes mellitus
Usually diagnosed after the age of 40
More than 85% of people with type 2 diabetes are
obese
Native Americans, African Americans, and Hispanic
Americans are at an increased risk
ASSESSMENT
Assess for signs and symptoms of hyperglycemia
Polyuria, polydipsia, polyphagia, weight loss, fatigue,
blurred vision, flushed dry skin, fruity breath odor,
rapid deep breathing
Assess for signs and symptoms of hypoglycemia
Anxiety, restlessness, tingling (in hands, feet, lips, or
tongue, chills, cold sweats, confusion, cool pale skin,
drowsiness, excessive hunger, headache, irritability,
nausea, tachycardia, tremor, weakness
Assess for signs of altered tissue response
Decrease wound healing, recurrent infection,
especially on the skin
Serum glucose levels Fasting blood glucose ≥ 126 mg/dl on two
occasions
Random blood glucose ≥ 200 mg/dl with DM signs
Glucose tolerance test Fasting blood sugar is obtained before ingestion
of glucose load, blood samples drawn 30min, 1, 2, 3, 4, and sometimes 5 hours after
Diagnostic for DM if 2 hour result is 200 mg/dl or greater
Glycosylated hemoglobin (A1c) Measures glycemic control over 60-120 day
period
Analysis
Activity intolerance related to fatigue
Anxiety related to potential complications
Deficient knowledge related to diabetes self-
management
Imbalanced nutrition: more than body
requirements related to increased caloric
consumption
Risk for impaired skin integrity related to
compromised circulation
Risk for injury related to blurred vision, fatigue
Planning
Maintain optimal body weight
Remain free from infection
Avoid complications
Increase understanding of disorder and
treatment
Promote adaptive coping behaviors
Implementation
Basic care and comfort measures
Evaluation
Client maintain optimal body weight
Client has no signs and symptoms of infection
Client is free from evidence of complications
Client verbalizes knowledge of DM and its
treatment
Client demonstrates adaptive coping behaviors
Physiological: Aim towards target glucose, glycosylated hemoglobin,
lipid and BP levels according to American Diabetes
Association
Modest calorie restriction for weight loss (type 2)
Regular aerobic exercise
Daily foot care
Prevention of complications by removing coexisting
risk factors (smoking, htn, hyperlipidemia, nephrotoxic
drug use)
Safety, Infection control, reduction of risk potential
For hyperglycemic crisis, administer IV fluids with insulin drip and insulin replacement
Patient should inject insulin into abdominal site on days when arms and legs are exercised
Treat all injuries, cuts, and blisters promptly
Assessment of feet
Skin temperature
Sensation
Soft tissue injuries
Corns, calluses, dryness
Pulses and deep tendon reflexes
Hair distribution
Oral Antidiabetic agents
Insulins
Rapid-acting
Humalog, NovoLog, Apidra
Short-acting
Regular R, Exubera (inhaled)
Intermediate-acting
Lente, NPH
Long-acting
U, Lantus, Levemir
Combination insulin
70/30; 50,50; and 75/25 Humalog mix
Action Appearance Onset Peak Duration
Rapid Clear 5-10 min 1 hr 2-4 hrs
Short Clear 30-60 min 2-4 hrs 4-6 hrs
Intermediate Cloudy 2-4 hrs 4-10 hrs 10-16 hrs
Long Clear 1 hr None 24 hrs
Self-Monitoring of Blood Glucose Recommended for all DM patients, regardless of
type
Pt’s with type 1 should test 3+ times daily (before each meal, before bed, and possibly in the middle of the night)
Pt’s with type 2 don’t have to monitor as often
All pts should monitor more when: Starting a new med or insulin or dosage changes
Sick or under stress
Weight changes
You think your glucose level is too high or low
Your eating or exercise habits change
Insulin self-administration
Video
http://www.youtube.com/watch?v=KP6Zm9vl3F
M&feature=related
Diet
Limitation of alcohol due to its hypoglycemic
effects and judgment impairment
Use of artificial sweeteners to maintain blood
glucose levels
Nutritive sweeteners contain calories but do not cause
significant rise in blood glucose (xylitol, fructose,
sorbitol)
Non-nutritive sweeteners contain little to no calories
and cause no rise in blood glucose levels (saccharine,
aspartame, sucralose)
Encourage pt to eat a well-balanced, nutritious
diet
Encourage regular
physical activity to
increase carb
metabolism,
lose/maintain
weight, increase
insulin sensitivity,
increase HDL levels,
lower triglyceride
levels, lower BP,
and reduce stress
1. An adult client with type 1 diabetes is
scheduled for cataract surgery in the
Same-Day Surgery Department. On
arrival, the client’s fingerstick blood
glucose is 210 mg/dl. The nurse should
a. Add an insulin drip to the IV therapy
b. Reschedule the surgery for another date
c. Instruct the client to ambulate
d. Contact the client’s HCP
D. Contact the client’s HCP
Blood glucose over 180 mg/dl is considered to be
hyperglycemia
Both emotional and physical stress can elevate.
The nurse does not initiate and insulin drip without
orders from a physician.
Clients who use insulin are at increased risk for
hypoglycemia when there is an increase in physical
activity.
1. An adult client who has type 2 diabetes
and requires insulin tells the nurse about
feeling trembly, weak, and anxious
before supper. The nurse should:
a. Tell the client to lie down for 30 minutes.
b. Have the client drink a glass of milk or orange
juice
c. Contact the client’s physician to decrease the
insulin dose
d. Administer the next dose of insulin
B. Have the client drink a glass of milk or orange juice
Hypoglycemia is a blood glucose level below 70 mg/dl. The signs and symptoms include: confusion, irritability, diaphoresis, tremors, hunger, weakness, and visual disturbances
Contacting the physician and having them lay down would delay treating the possible hypoglycemia
Administering insulin would cause the blood sugar to go even lower