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Risks for diabetes
- obesity
- highfat diet
- sedentary lifestyles
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Diabetes Type I Patho (6)
- Juvenile onset
- genetic disposition
- autoimmune disorder
- long, preclinical period
- *DKA in ER
- *indulin depedent
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Type II diabetes causes(4)
- insulin resistance
- decrease insulin production by the pancrease
- increased glucose production by liver
- altered hormones by adipose tissue
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Type II Risk factors
- Obesity
- sedentary lifestyle
- urbanization
- ethnicity ( native americans, AA & hispanics)
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Metabolic Syndrome (6)
- *increases chance of developing type 2DM
- high triglycerides
- HTN
- ^ in LDLs
- decreased in HDLs
- insulin resistance
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Type I DM clinical manifestations
- Polyura
- Polydipsia
- Polyphagia
- *weakness & fatigue
- sudden weight loss
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Type II DM clinical manifestation (4)
- fatigue
- recurrent infections
- delated wound healing
- visual changes
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Diabetes Diagnostic Testing (4)
- fasting blood sugar
- random blood sugar >200
- 2 hour glucose tolerance test
- HgbA1C - 6.5
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Fasting plasma glucose
- pt NPO for 8 hrs
- 70 - 110 is normal
- 111-125, impaired fasting glucose; prediabetic
- >126 twice in a row = DM
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Random plasma glucose
- >200 and has to have s&s of hyperglycemia
- polyura
- polydipsia
- polyphagia
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2- hourr oral glucose tolerance test
- *given loading dose, after 2 hr glucose should be back to normal range
- 110 - 139 - normal
- 140 - 199 - prediabetic
- >200 DM
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Diabetes pt teaching
- Characteristics of their insulin
- when & how to check bs
- urine testing - ketones
- medical ID
- s&s of hypo/hyperglycemia
- foot care
- meds
- sick days
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Goals of diabetic treatment (3)
- HgbA1C < 7
- fasting blood glucose 90 - 130
- post prandial blood sugar <180 (2 hours after eating)
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Diabetic treatment Team (6)
- RN
- Nutritionist
- Podiatrist
- opthalmologist
- exercise therapy
- endocrinologist
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Type I diabetic nutritional therapy (3)
- adjust insulin according blood sugar
- watch carbs
- balance diet with exercise
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Type II diabetic nutritional therapy
- achieve things wdl
- lipids
- glucose
- blood pressure
- hgba1c
- loose weight
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Diabetic food composition
- cholesterol <300
- Na <2400grams/day
- fiber 25-30grams / day
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Diabetic risks of exercise
- *hypoglycemia!
- eat 15 grams of carbs w/in 30 mins of exercise
- exercise 1 hr after meals
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Diabetic exercise guidelines
- *after meal ( 1hr), checkk bs
- <100 - eat 15 gr carbs, retest in 30 mins, if <100 again don't exercise
- >240 - check for ketones, positive - dont exercise
- >300 dont exercise
- *hypoglycemia can occur up to 48 hrs after exercise
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Diabetics, foods to avoid
- alcohol
- simple sugars
- adding sugars to foods
- excess sodium
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When to check blood sugars ( 6)
- before meals
- before & after exercise
- suspects hypoglycemia
- Q4H when sick
- maybe HS
- after meals (2hrs)
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Gliptizide ( Glucotrol) MoA, SE & nursing implications
- *sulfonylurea
- MoA: stimulate insulin production
- SE: hypoglycemia & weight gain
- Implications: give 30mins before meals, effects last 24 hrs
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Metformin (Glucophage) MoA, SE, implications
- -biguanide
- MoA: decrease glucose production & increase insulin sensitivity
- SE: diarrhea & lactic acidosis
- Implications: doesn't cause hypoglycemia, can be used with sulfonylureas
- *hold 48hrs before IV contrast until creatine is WDL
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Acarbose (precose) MoA, SE, Implications
- MoA: delay glucose absorption in GI
- SE: gas, abd pain, diarrhea
- Implications:
- -take with first bite of meal to block glucose
- - does't cause hypoglycemia
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Glitzone (actose. avandia) MoA, SE, Implications
- MoA: increase glucose sensitivity
- SE: weight gain and increased cardiac events
- implications: no hypoglycemia
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Types of Combination Insulin
- 70/30 (NPH/reg)
- 50/50 (NPH/reg)
- 75/25 (NPH/ lispro)
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Diabetic sick day managements
- - monitor blood sugar Q4H
- - test for ketones
- -don't stop insulin
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Diabetic pre op labs
- HgbA1C
- CBC
- EKG
- CXR
- electrolytes
- renal function
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Diabetic post op care
- IV insulin until they can tolerate PO
- BS 4-6x/ day
- avoid foley
- steril dressing changes
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DKA patho
- Cells starve r/t lack of insulin
- fat & protein break down
- gluconeogenesis
- - both lead to ketone biproducts
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early DKA s&s
- lethargy
- weakness
- poor skin turgor
- dry
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Rapid insulin
- onset: 5-15 mins
- peak: 1- 1.5
- duration: 3-4hrs
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short acting insulin
- onset: 30mins - 1 hr
- peak: 2-3 hrs
- duration: 4-6hrs
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intermediate acting insulin
- onset: 2 hrs
- peak: 6-8
- duration: 12-16 hrs
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long acting insulin
- onset: 1-2 hrs
- peakless
- durationg: 24 hrs
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