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Diabetes- ATI Testing

What are the risk factors for DM?
Genetics may predispose an individual to the occurrence of type 1 or type 2 diabetes.
Toxins and viruses can predispose an individual to diabetes by destroying the beta cells leading to type 1 diabetes mellitus.
Obesity, physical inactivity, high triglycerides (greater than 250 mg/dL), and hypertension may lead to the development of insulin resistance and type 2 diabetes.
Secondary causes of diabetes include pancreatitis and Cushing’s syndrome.
What blood glucose level is considered hyperglycemis?
Blood glucose level usually greater than 250 mg/
What are the diagnostic testing for DM?
?? Symptoms of diabetes plus casual plasma glucose concentration of greater
than 200 mg/dL (without regard to time since last meal)
?? Fasting blood glucose greater than 126 mg/dL
?? Two-hour glucose greater than 200 mg/dL with an oral glucose tolerancetest
What is glycosylated hemoglobin (HbA1c)?
What are the normal values?
The normal reference range is 4% to 6%, but an acceptable target for clients who have diabetes may be 6.5% to 8%, with a target goal of less than 7%.

HbA1c is the best indicator of the average blood glucose level for the past120 days.

What are the nutritional guidelines for patient’s with DM to follow when sick?
?? Monitor blood glucose every 3 to 4 hr.
?? Continue to take insulin or oral antidiabetic agents.
?? Consume 4 oz of sugar-free, non-caffeinated liquid every 0.5 hr to prevent dehydration.
??Test urine for ketones and report to provider if they are abnormal (the level should be negative to small).
Call the health care provider if:
?? Blood glucose is greater than 240 mg/dL.
??Fever is greater than 38.9° C (102° F), does not respond to acetaminophen, or lasts more than 12 hr.
What patient education should be provided for S & S of hypoglycemia?
?? Treat with 15 to 20 g carbohydrates
Examples – 4 oz orange juice, 2 oz grape juice, 8 oz milk, glucose tablets per manufacturer’s suggestion to equal 15 g
?? Recheck blood glucose in 15 min.
?? If still low (less than 70 mg/dL), give 15 to 20 g more of carbohydrates.
?? Recheck blood glucose in 15 min.
?? If blood glucose is within normal limits, take 7 g protein (if the next meal ismore than an hour away).
Example – 1 oz of cheese (1 string cheese), 2 tablespoons of peanutbutter, or 8 oz of milk
What patient education should be provided fro S &S of hyperglycemia?
?? Encourage oral fluid intake.
?? Administer insulin as prescribed.
?? Restrict exercise when blood glucose levels are greater than 250 mg/dL.
?? Test urine for ketones and report if abnormal.
?? Consult the provider if symptoms progress.
Oral hypoglycemics
?? Biguanides – Metformin HCL (Glucophage)
Reduces the production of glucose through suppression of gluconeogenesis
What is the client education for glucophage?
Instruct the client to take vitamin B12 and folic acid supplements.
Instruct the client to contact the provider if signs of lactic acidosis
(myalgia, sluggishness, somnolence, hyperventilation) are experienced.
Instruct the client that this medication may be taken during pregnancy for gestational diabetes.
Oral hypoglycemics
?? Sulfonylureas – Tolbutamide (Orinase), chlorpropamide (Diabinese), and glyburide (DiaBeta, Micronase)
Stimulates insulin release from the pancreas
What are the client education for sulfonylureas?
Instruct the client to avoid use during pregnancy.
Instruct the client to avoid alcohol due to disulfiram effect.
Oral hypglycemics
?? Thiazolidinediones – Rosiglitazone (Avandia) and pioglitazone (Actos)
?? Increases cellular response to insulin by decreasing insulin resistance
?? Nursing Considerations
Monitor for fluid retention, especially in clients with a history of heart failure.
Monitor the client’s LDL and triglycerides for elevations.
?? Client Education
Instruct the client to have serum alanine aminotransferase (ALT)
checked every 6 months after baseline.
Oral hypoglycemics
?? Alpha-Glucosidase Inhibitors – Acarbose (Precose) and miglitol (Glyset)
?? Slows carbohydrate absorption and digestion
?? Nursing Considerations
Alert the client of GI discomfort common with these medications (abdominal distention, cramps, excessive gas, diarrhea).
Monitor for iron deficiency anemia (hemoglobin and iron levels).
?? Client Education
Instruct the client to have liver function tests performed every 3
months or as prescribed.
Report jaundice immediately.
What are the normal reference range for blood glucose levels?
70 to 120 mg/dL.
What are the two main complications of DM?
?? Diabetic ketoacidosis (DKA) -hyperglycemia (greater than 300 mg/dL) resulting in the breakdown of body fat for energyband an accumulation of ketones in the blood and urine.
DKA is more common in clients with type 1 diabetes mellitu
?? Hyperglycemic-hyperosmolar -characterized by profound hyperglycemia (greater than 600 mg/dL), dehydration, and an
absence of ketosis.
HHS is more common in older adult clients and in clients with untreated or undiagnosed type 2 diabetes mellitus.
What are the objective data for diabetic ketoacidosis?
Polyuria, polydipsia, and polyphagia (early signs)
Change in mental status
Signs of dehydration (dry mucous membranes, weight loss, sunken eyeballs resulting from fluid loss such as polyuria)
Kussmaul respiration pattern, rapid and deep respirations, fruity breath (DKA/metabolic acidosis)

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