Diabetes Mellitus: Treatment & Management - PDF

LAKELAND COMMUNITY COLLEGE URS 1250 NURSING CARE OF ADULTS II EXAM 2 CONCEPT OF METABOLISM DIABETES MELLITUS ROWENA A. BAUTISTA, MSN, RN, CMSRN TOPIC OUTLINE US Data & Statistics Overview & Pathophysiology Clinical Manife...

LAKELAND COMMUNITY COLLEGE URS 1250 NURSING CARE OF ADULTS II EXAM 2 CONCEPT OF METABOLISM DIABETES MELLITUS ROWENA A. BAUTISTA, MSN, RN, CMSRN TOPIC OUTLINE US Data & Statistics Overview & Pathophysiology Clinical Manifestations Contributing Factors Screening Tests o Pathological Outcomes o Clinical Management PATHOLOGICAL OUTCOMES  Macrovascu Microvascul Acute lar ar (Chronic) (Chronic) Diabetic Dermopathy Atherosclerosi Ketoacidosis Nephropathy s (DKA) Retinopathy Peripheral Hyperosmolar Neuropathy Vascular Hyperglycemic Cardiovascular State (HHS) Cerebrovascul ar LONG TERM DIABETES CONSEQUENCES DIABETIC KETOACIDOSIS AND HYPEROSMOLAR HYPERGLYCEMIC STATE DKA HHS Commonly seen in Type I DM Commonly seen in Type II DM Typically, > 300 mg/dL Typically, > 600 mg/dL Osmolality > 340 mOsm/L Osmolality > 340 mOsm/L Kussmauls’s respiration Shallow breaths Confusion Lethargy Develops quickly Develops slowly LONG-TERM EFFECTS OF DIABETES  DIABETIC DERMOPATHY “shin spots”, “diabetic skin spots” Small, round, oval patches of discolored skin. Causes: — Microvascular damage — Trauma or injury NEPHROPATHY Damages small blood vessels in kidney including glomeruli. Albuminuria (protein) in urine. 70% also have HTN.  RETINOPATHY Microvascular damage and occlusion of the retina. Other Ocular Disorders: Glaucoma —affects the optic nerve Cataracts —affects the lens  PERIPHERAL NEUROPATHY Peripheral nerves transmits signals from CNS to the rest of the body. Sensory Neuropathy —Loss of sensation, numbness, tingling Motor Neuropathy —weakness, cramps  AUTONOMIC NEUROPATHY ANS controls involuntary functions. Cardiovascular System —Postural hypotension Nervous System —Erectile dysfunction Gastrointestinal System —Gastroparesis  PERIPHERAL VASCULAR DISEASE Narrowing or blockage of blood vessels. Clotting disorders – often BLE’s Risks: —infection, gangrene, amputation CARDIOVASCULAR DISEASE CLINICAL MANAGEMENT PHARMACOTHERAPY (MAJOR CLASSES) Control hepatic Stimulates Slows absorption glucose pancreas to make of starches/CHO production more insulin α-Glucosidase Biguanides Sulfonylureas inhibitors Thiazolidinedion Meglitinides es BIGUANIDES metformin – preferred initial pharmacological agent. —↓ rate of hepatic glucose production. —↑ glucose uptake in the muscles. —Do not use in patients with kidney, liver, or heart failure. —Hold for 48 hours after procedures using contrast dye. SULFONYLUREAS Oldest class of oral hypoglycemics. Stimulates pancreas to make more insulin. Take with meals. Watch for hypoglycemia. —glyburide (Micronase, Diabeta) —glipizide (Glucotrol) —glimepiride (Amaryl) α-GLUCOSIDASE INHIBITORS “Starch Blockers” Best used for those with normal FBS but elevated Post Prandial Plasma Glucose (PPG). Take with 1st bite of meal. Monitor liver enzymes. —acarbose (Precose) —miglitol (Glyset)  DIPEPTIDYL PEPTIDASE-4 Boost incretin, hormones INHIBITOR produced by the gut in response (DPP-4) to food intake. —sitagliptin (Januvia) —linagliptin (Tradjenta) —alogliptin (Nesina) —saxagliptin (Onglyza)  INCRETIN MIMETICS (GLP-1 RA) Mimic the effects of incretin. May combine with oral agents. Do not use with Insulin. —dulaglutide (Trulicity) —exenatide (Byetta/Bydureon) —liraglutide (Victoza) —semaglutide (Ozempic)  INSULIN OVERVIEW Injectable drugs to control: —Type 1, dependent —Type 2, if not controlled by other means 1920’s – Banting & Best 1980’s – recombinant DNA  BANTING AND BEST 1920 Frederick Banting, a Canadian surgeon and Charles Best, a medical student, successfully isolated the hormone insulin for the first time. INSULIN (REFER TO HANDOUT) Rapid-acting – bolus Short-acting – bolus/prandial Intermediate-acting Long-acting – basal Premixed – combination  DRAWING UP TWO DIFFERENT INSULINS 1. Draw air into syringe. 2. Inject air into NPH insulin. 3. Inject air into Short- Acting Insulin. 4. Draw Short-Acting Insulin 5. Draw NPH Insulin  INSULIN PUMP Delivers Insulin via an infusion set. —through a thin tube that goes under the skin. Mimics a healthy pancreas. —Basal dose —Bolus dose Insulin Pump safety and MRI.  PHASES OF INSULIN ACTION Onset – when the effect of Insulin first begin Peak – when the Insulin is working at its “optimal” level Duration – how long the Insulin persists in the system PHARMACOTHERAPY: BEYOND BLOOD SUGAR CONTROL Blood Vessel Using Risk Exercise Damage Reduction Diet Blood Approach Heart Medication Pressure & Attack s Cholestero Stroke High Blood l Kidney Sugar Manageme Damage nt Nerve Damage  DIETARY RECOMMENDATIONS 1. Non-starchy Veggies —spinach, carrots, broccoli 2. Protein —chicken, salmon, eggs 3. Carbohydrates —whole grain foods, pasta, potatoes 4. Water is the best beverage choice Add: serving of fruit & dairy. Choose healthy fats  ROLE OF FIBER IN DM Fiber – best source of carbs —vegies, fruits, legumes —fiber binds and delays entry into the blood stream. Benefits: —Improves blood sugar control. —Digestive health —Weight management —Heart health PHYSICAL ACTIVITIES RECOMMENDATIONS TAKE ACTIONS: ESSENTIAL FOOT CARE TAKE ACTIONS: FOOT CARE TAKE ACTIONS: VISION CARE Complete a dilated eye exam every year Watching for retinopathy Call doctor immediately with: Blurred or double vision Narrowed field of vision Seeing dark spots Feeling pressure in the eyes Unusual difficulty seeing in dim light TAKE ACTIONS: MANAGING SKIN CARE Bathe daily with mild soap and lukewarm water Avoid scratches or bruises Gardener gloves Sunscreen Avoid long exposure to very cold weather Treat skin injuries quickly TAKE ACTIONS: SICK DAYS S – Sugar I – Insulin C– Carbohydrates K – Ketones PATIENT EDUCATION GENERATE SOLUTIONS: PATIENT/CAREGIVER WILL -- Demonstrates blood glucose test on self. Verbalize proper foot care. Verbalizes exercise guidelines. State when to contact physician. Verbalizes importance of outpatient DM education after discharge. Verbalizes target glucose ranges and A1C levels. GENERATE SOLUTIONS: PATIENT/CAREGIVER WILL -- Demonstrate SQ injection. States appropriate time schedule for insulin. States drug/drug and drug/nutrient interactions. States symptoms, treatment of hypoglycemia. States symptoms, treatment of hyperglycemia. Verbalizes sick day guidelines. States one day meal plan.