DM2 Flashcards
1
Q
DM nutrition mgmt plan
A
- eat from all food groups
- plan to eat meals nor more than 4-5 hrs apart
- type 1: increase calorie intake
- type 2: decrease calorie intake
- reduction of 500cal/day = weight loss of 1lb/week
2
Q
DM1 nutritional tx
A
- meal plan is based on individual’s usualy -food intake and is balanced with insulin and exercise patterns
- insulin regiment is managed day to day
3
Q
DM2 nutritional tx
A
- emphasis is based on achieving glucose, lipid, and blood pressure goals
- calorie reduction
4
Q
carbs in nutritional tx
A
- 130g/day
- fiber 14g/1000kcal
- sugar alcohols and nonnutritive sweeteners are safe when consumed with FDA daily intake levels
5
Q
glycemic diet
A
-the rise in BG levels after CHO containing food is consumed
6
Q
fats in nutritional tx
A
- less than 200mg/day of dietary cholesterol
- trans fats should be minimized
- limit <7% from saturated fats
7
Q
protein in nutritional tx
A
- suggested protein intake is 15-20%
- high protein diet no recommended as a weight loss method for diabetics (except for kids bc they need to grow)
8
Q
alcohol in nutritional tx
A
- high in calories
- no nutritive value
- promotes hypertriglyceridemia
- detrimental effects on liver
- can cause severe hypoglycemia
9
Q
diet teaching
A
- counting carbs
- USDA MyPyramid guide
- Plate method: 1200-1400 cals/day
10
Q
3 important things to teach with meal planning
A
- consistent eating habits
- relationship between food and insulin
- providing an individualized meal plan
11
Q
ways foods are organized into groups
A
- # of calories
- composition
- effects on blood glucose
12
Q
therapeutic effect of regular exercise
A
a decreased need for diabetes medicines in order to reach target BG goals
13
Q
role of exercise in DM
A
- improves uptake of glucose by the muscles
- reduces cardiovascular risk
- improves circulation and muscle tone
- lowers lipid blood concentration
- increased HDL
14
Q
exogenous insulin
A
- injected insulin
- required for DM1
- prescribed for DM2 who cannot control BG by other means
15
Q
basal bolus regimen
A
- closely mimic endogenous insulin
- includes a long acting (basal) once a day and a rapid/short acting (bolus) before meals
16
Q
goal of basal bolus regimen
A
achieve a near-normal glucose level of 80-120mg/dL before meals
17
Q
insulin storage
A
- store in a cool place
- do not heat/freeze
- in use vials may be left at room temp up to 4 weeks
- extra insulin should be refridgerated
- avoid exposure to direct sunlight
18
Q
nursing interventions for insulin
A
- cannot be PO
- regular is the only that can be IV
- subQ for self injection
- fastest absorption: abd, then arm/thigh, then butt
- rotate injections with one particular site
- do not inject site to be exercise
19
Q
insulin pumps
A
- continuous subQ insulin infusion
- insulin can be rapid or short acting
- insertion site changed q2-3 days
- requires frequent finger sticks q4h
20
Q
problems with insulin tx
A
- hypoglycemia
- allergic reaction
- lipodystrophy
- somogyi effect
- dawn phenomenon
21
Q
somogyi effect
A
- rebound effect in which an overdose of insulin causes hypoglycemia
- counterregulatory hormones release
22
Q
dawn phenomenon
A
characterized by hyperglycemia present on awakening in the morning
d/t release of counterregulatory hormones in predawn hours
23
Q
oral agents
A
- works to improve mechanisms by which insulin and glucose are produced and used in the body
- works on these 3 defects of DM2: insulin resistance, decreased insulin production, & increased hepatic glucose production
- *sulfonylureas, meglitinides, biguanides, a-glucose inhibitors, thiazolidinediones
24
Q
incretin mimetic
A
- synthetic peptide
- stimulates release of insulin from beta cells
- subQ injections in a prefilled pen
- suppresses glucagon secretion
- reduces food intake
- slows gastric emptying
- not to be used with insulin
25
b-adrenergic blockers
- masks symptoms of hypoglycemia
| - prolong hypoglycemic effects of insulin
26
thiazide/loop diuretics
can potentiate hyperglycemia by inducing K loss
27
DM1 in pediatrics
* 4-5 yrs: can help with injection
* 6-7 yrs: can tell you if foods have sugar
* 8-10 yrs: can give own injection and testing with supervision
* 11-13 yrs: can measure own insulin
* 14+ : can do mixture of insulin
28
geriatric considerations
-prevalence of DM increase with age
-undiagnosed & untreated DM more common
-hypoglycemic awareness needed
-delayed psychomotor function
-decline in cognitive function
0functional limitations: visual acuity, manual dexterity
29
pancreas transplant
- used for DM1 who also have ESRD or plan to have/had a kidney transplant
- usually kidney & pancreas transplants are done together
- eliminates the need for exogenous insulin
- can also eliminate hypoglycemia & hyperglycemia
30
immediate tx needed on sick day
- persistent emesis and unable to keep down any fluids
- persistent diarrhea with weakness
- labored or difficulty breathing
- positive urine ketones after 12-24hr of tx
- changes in mental status
31
pancreatic islet cell transplant
- islets are harvested from the pancreas of a deceased organ donor
- pain & recovery time are diminished
32
overall goals in mgmt of DM
- active pt participation
- few or no episodes of acute hyperglycemic emergencies or hypoglycemia
- maintain normal blood glucose levels
- prevent or delay chronic complications
- lifestyle adjustments with minimal stress
33
sick day pt guideline
- continue meals, may need insulin more than the usual
- glucose check q3-4h
- maintain hydration
- need at least 150gms of CHO
- evaluate OTC meds
34
health promotion of DM
- identify those at risk
| - provide routine screening for overweight adults over age 45
34
reasons to call the MD on sick day
- vomiting more than once
- diarrhea 5x+ or 24hr+
- difficulty breathing
- BG>300mg/dL on 2 consecutive readings
- +ketones in urine
- changes in mental status
