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Prittyrick
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Glucose monitoring
- Self monitoring of blood glucose (SMBG)
- - proper technique
- - store equipment properly
- - 2-4x day if taking insulin
- - less frequently if not taking insulin
- - before and after exercise- esp type 1
- - all pts: hypo/hyperglycemic
- Whole blood tends to run higher than venous blood
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Review agents for DM
- insulin and oral
- know onset, peak, duration humalog (lispro), regular insulin, lantus
- injection administration and techniques
- oral agents: 2nd generation agents (Glucotrol, biguanides (glucophage), thiazolinediones (actos): MOA and teaching
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Insulin
- can be used with type 1 and 2
- many different preparation
- alone or in combo
- goal is consistent glu levels
- educate pt about administration, adjustment to use, side effects
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Types of Insulin
- Rapid acting, humalog (lispro), onset 15 min, peak 1hr, duration 2-4 hr
- short acting, regular R novolin, onset 30 min-1 hr, peak 2-4 hr, duration 4-6 hr
- intermediate acting, NPH (humlin) N, onset 3-4 hrs, peak 4-12 hr, duration 16-20 hr
- long acting (very), Lantus, onset 1 hr, peak none, duration 24 hr
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Insulin guidelines
- eat within 15 mins with rapid acting
- eat within 30 mins with short acting
- **** only Regular insulin can be used IV
- NPH may be given 2x/day
- assess onset and peaks
- never mix another insulin with lantus
- lantus any time of day, but at the same time everyday
- *** review insulin: pre- op, sick days, diets (NPO, clear liquid),
- look at pharm
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Insulin
administration storage
- Rotate site
- - prevent lipodystrophy
- - abdomen is preferred site for pts
- Stable at room temp x 1 month
- refrigerate extra
- " roll" bottle of NPH
- protect from sunlight
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Types of insulin
- traditional injections
- insulin pens
- jet injections
- insulin pump
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Nursing management
- long term management
- avoidance of potential complication
- Nursing dx
- ineffective self- health management
- imbalance nutrition: more than body requirement
- risk for injury
- risk for peripheral neurovascular dysfunction
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Nursing management 2
- Problem solving/healthy coping
- - assessment, including pt perceptions and attitudes, lifestyle preferences, coping stragtegies
- - eating out, vacations, etc
- - meds, infection, physical or emotional stress may increase glucose
- - accommodations for visual impairment
- - when to contact PCP
- - lifelong learning
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Nursing management 3
- reducing risks:
- foot care
- eye care
- skin care
- oral hygiene
- BP control
- lipid control
- medical alert bracelet
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nursing consideration
for humalog
- food ready right away
- check BS within a 1hr
- monitor for hypoglycemia
correct insulin, dosage, syringe
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