Diabetes Cheat Sheet PDF

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Diabetes cheat sheet with numerical values...

Description

Diabetes mellitus – type 2

Pathophysiology/Description • Diabetes is a multisystem disease of glucose metabolism that is marked by hyperglycemia

Priority Laboratory Tests/Diagnostics Diagnosis made with one of the following ◦ Fasting blood glucose 126 mg/dL or higher

• It relates to impaired usage of insulin, abnormal production of insulin or both occurring at the same time

◦ A1C of 6.5% or higher

• Two most common types of diabetes mellitus are types 1 and 2. Type 2 diabetes is the most prevalent

◦ Using a glucose load of 75 g during an oral glucose tolerance test, a two-hour plasma level that is equal to or greater than 200 mg/dL

• Type 2 is marked by insulin resistance, inadequate insulin secretion or a combination of both ◦ Insulin resistance: Body tissues do not respond to insulin’s action due to unresponsive or insufficient numbers of insulin receptors ◦ Inadequate insulin secretion: Cells of the pancreas become fatigued and so insulin production is decreased • Risk factors ◦ Family history. More likely to get the condition if there are first degree relatives with it ◦ Obesity or overweight. Fat cells are resistant to insulin ◦ Certain ethnicities. It is more prevalent in Asian Americans, African Americans, Hispanics, Pacific Islanders and Native Americans ◦ Being older than 40 years of age • Type 2 diabetes has a gradual onset. Many persons do not know they have the condition until it is detected on routine lab testing • Diabetes is a life-altering condition

Priority Assessments or Cues Ask about symptoms such as polydipsia, polyuria, polyphagia, fatigue, recurrent infections, visual changes and poor wound healing. Determine blood glucose level Ask about management of the condition such as meal planning and medication administration

◦ Random blood glucose greater than or equal to 200 mg/dL in a client who has the classic symptoms of hyperglycemia or is in a hyperglycemic crisis ◦ The first 3 items above must be repeated to confirm the diagnosis. However, the fourth does not need to be repeated

Priority Interventions or Actions Administer medications and monitor blood glucose for effectiveness of dosage Monitor meal intake Schedule meeting with dietician to talk with client about nutrition planning • Schedule meeting with diabetic educator to ensure client’s knowledge needs are met

Priority Potential & Actual Complications Nephropathy, leading to kidney failure, neuropathy, leading to sores and amputations and retinopathy, leading to blindness Hyperglycemic hyperosmolar syndrome, hypoglycemia Conditions related to the heart, brain and blood vessels • Gastroparesis • Fungal infections

• Measure vital signs Perform skin assessment, focusing on feet. Diabetes causes neuropathy and individuals with the disease can have wounds on their soles without knowing it. Untreated wounds can lead to amputations • Perform neurological assessment, focus on the eyes. Blindness is a major complication of diabetes • Review labs, including kidney function tests. Nephropathy is a major complication of diabetes • Determine social support • Assess client’s understanding of disease management

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Priority Exemplar

Priority Nursing Implications Understand that most people with diabetes, even if the condition is controlled without medications, will require medicines at some point because of the progressive nature of the condition Persons with type 2 diabetes who take oral medications can require insulin in times of stress, as in acute illness Metformin must be stopped for surgery or if having a procedure that uses a contrast medium. Resume 48 hours post procedure but get creatinine level first. Not stopping the drug will increase the risk of metformin-induced lactic acidosis

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• The thiazolidinediones can only be had through a restricted access program because of their serious cardiac adverse effects • exenatide causes acute pancreatitis and kidney problems and liraglutide should not be used in clients with family or personal history of medullary thyroid cancer

Priority Medications biguanides ◦ metformin, the most effective first line treatment for type 2 diabetes ◦ Decrease production of glucose in liver and enhances transport of glucose into cells ◦ Must not be used if kidney or liver disease, or heart failure. Major side effect is lactic acidosis

• Combination oral therapy ◦ Combination of two different classes of medications into one pill ◦ Advantageous, as only 1 pill is taken instead of two different pills, thus increasing medication compliance

Priority Education/Discharge Issues Measure blood glucose regularly • Adhere to exercise and meal plan Teach about signs and symptoms of hypo and hyperglycemia Teach proper administration as well as adverse effects of medications. Ensure understanding of adherence to exercise and meal planning

sulfonylureas

• Meal consumption in relationship to insulin administration

◦ glipizide, glyburide, glimepiride

• Wear diabetes identification

◦ Increase production of insulin by the pancreas

• Educate on the importance of having A1C measured regularly to determine effectiveness of treatment protocol

◦ Major side effect is hypoglycemia thiazolidinediones ◦ Pioglitazone, rosiglitazone ◦ Increase uptake of glucose in muscle and decrease endogenous production of glucose

• Teach proper foot care • Teach the importance of getting eye exams • Teach importance of getting annual physicals, ensuring kidney function is assessed

◦ Major side effect is adverse cardiovascular events • a-Glucosidase inhibitors ◦ acarbose, miglitol

Go To Clinical Answers

◦ Cause absorption of starches from the gastrointestinal tract to be delayed

Text designated by are the top answers for the Go To Clinical related to Diabetes type 2.

◦ Must be taken with the first bite of food, most effective in lowering postprandial blood glucose • dipeptidyl peptidase-4 ◦ linagliptin, saxagliptin, sitagliptin, alogliptin ◦ Increase the activity of incretin. Stimulate insulin release from pancreatic B-cells and decrease the liver’s production of glucose ◦ Does not cause weight gain as the other classes of drugs do • sodium-Glucose Co-Transporter 2 ◦ canagliflozin, dapagliflozin ◦ Decrease reabsorption of glucose in the kidneys and increase its excretion through urine ◦ Causes urinary tract and genital infections • glucagon-like Peptide-1 Receptor Agonists ◦ exenatide, exenatide extended-release, dulaglutide, albiglutide, lixisenatide, liraglutide ◦ Decrease secretion of glucagon, stimulate release of insulin and slow gastric emptying, thus causing a feeling of fullness and satiety

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Image 12-2: What are the top 3 instructions for the client with this diabetic foot ulcer?

Chapter 12 - Hormonal

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Diabetes mellitus – type 1

Pathophysiology/Description • Diabetes is a multisystem disease of glucose metabolism that is marked by hyperglycemia • Two most common types of diabetes mellitus are types 1 and 2. Type 1 is less prevalent than type 2 and usually affects younger individuals • Type 1 is an autoimmune disorder where antibodies are developed against the pancreas B-cells or against insulin. • Has a genetic link • Has a sudden onset once the pancreas can no longer produce insulin. Some individuals are diagnosed initially when they are in diabetic ketoacidosis • Classic symptoms, known as the 3 Ps

◦ Random blood glucose greater than or equal to 200 mg/dL in a client who has the classic symptoms of hyperglycemia or is in a hyperglycemic crisis ◦ The first 3 items above must be repeated to confirm the diagnosis. However, the fourth does not need to be repeated

Priority Interventions or Actions • Administer insulin and monitor blood glucose for effectiveness of dosage • Monitor meal intake • Schedule meeting with dietician to talk with client about nutrition planning

◦ Polyuria (frequent voiding), because of the osmotic effect of glucose

• Schedule meeting with diabetic educator to ensure client’s knowledge needs are met

◦ Polydipsia (excessive thirst), because of the osmotic effect of glucose

• Have newly diagnosed client teach back on blood glucose checks and insulin preparation and injection

◦ Polyphagia (excessive hunger), because of lack of glucose usage for energy • Exogenous insulin is required for life • Diabetes is a life-altering condition

Priority Assessments or Cues • Ask about symptoms such as polydipsia, polyuria, polyphagia, fatigue, weight loss. Determine blood glucose level • Ask about management of the condition such as meal planning and medication administration • Assess knowledge of insulin preparation and administration

• Nephropathy, leading to kidney failure. Neuropathy, leading to sores and amputations. Retinopathy, leading to blindness • Hypoglycemia • Somogyi Effect, caused by high dose of insulin that causes some counter regulatory hormones to be released, which then causes rebound hyperglycemia in the morning • Dawn phenomenon occurs similar to the Somogyi effect but the treatment for both is different

• Assess ability to manage diabetes at home • Measure vital signs

• Diabetic ketoacidosis, hypoglycemia

• Perform skin assessment, focusing on feet

• Conditions related to the heart, brain and blood vessels

◦ Diabetes causes neuropathy and individuals with the disease can have wounds on their soles without knowing it ◦ Untreated wounds can lead to amputations • Perform neurological assessment, focus on the eyes. Blindness is a major complication of diabetes • Review labs, including kidney function tests. Nephropathy is a major complication of diabetes • Determine social support • Assess client’s understanding of disease management and physical ability to prepare and administer insulin injections

Priority Laboratory Tests/Diagnostics • Diagnosis made with one of the following ◦ Fasting blood glucose 126 mg/dL or higher ◦ A1C of 6.5% or higher ◦ Using a glucose load of 75 g during an oral glucose tolerance test, a two-hour plasma level that is equal to or greater than 200 mg/dL

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Priority Potential & Actual Complications

Priority Exemplar

• Atrophy or hypertrophy of tissue at injection site

• Gastroparesis

Priority Nursing Implications • Timing of a meal is crucial based on the type of insulin being administered • It is important to involve willing family members in the education regarding diabetes management of their loved one, as all persons living in the home with the individual will be impacted in some way by the individual’s diagnosis of diabetes • Knowing that with type 1 diabetes the individual will need to take exogenous insulin to sustain life • Premix insulin formulas are better for individuals who lack the ability to prepare insulin for themselves. These might be individuals with cognitive, physical or visual impairments • Insulin pumps must be used only if the individual is capable to manage the pump

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• Educate on the complications of insulin therapy

Priority Medications • Rapid-acting insulin

• Wear diabetes identification • Educate on the importance of having A1C measured regularly to determine effectiveness of treatment protocol

◦ lispro, aspart, glulisine

• Teach proper foot care

◦ Onset 10-30 minutes, peak 30 minutes - 3 hours, duration 3-5 hours

• Teach the importance of getting eye exams

◦ Administered via subcutaneous route but can be given intravenous in a monitored setting • Short-acting insulin

• Teach importance of getting annual physicals, ensuring kidney function is assessed • Teach about options for insulin administration, like insulin pen and insulin pump

◦ regular ◦ Onset 30 minutes- 1 hour, peak 2-5 hours, duration 5-8 hours ◦ Administered via subcutaneous route

TYPES OF INSULIN

• Intermediate-acting insulin ◦ NPH ◦ Onset 1.5-4 hours, peak 4-12 hours, duration 12-18 hours

Types/Brand

Onset/Peak/Duration

◦ Administered via subcutaneous route Aspart-Novolog

◦ glargine, detemir, degludec ◦ Onset 0.8-4 hours, peak no identified/pronounced peak, duration 16-24 hours ◦ Administered via subcutaneous route

Rapid-acting

• Long-acting insulin

Lispro-Humalog

• Onset: 10 - 30m • Peak: 30m - 3hr

Glulisine-Apidra

• Duration: 3 - 5hr

• Inhaled insulin

◦ humulin R U-500, toujeo U-300

Priority Education/Discharge Issues • Measure blood glucose regularly • Insulin ◦ Storage ◦ Care of insulin container ◦ Preparation and administration ◦ Appropriate injection sites and injection site rotation ◦ Side effects • Client teach back on insulin administration and blood glucose checks • Teach about signs and symptoms of hypo and hyperglycemia • Teach proper administration as well as adverse effects of medications • Meal consumption in relationship to insulin administration

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Short-acting Intermediateacting

• More concentrated insulin

Long-acting

◦ Several combinations of premixed insulins (2 insulins combined)

Intermediate + Rapid

• Combination therapy

Inhaled insulin-Afrezza

Intermediate + Short

◦ afrezza ◦ Onset 12-15 minutes, peak 60 minutes, duration 2.5-3 hours

Regular-Humulin R

• Onset: 30 - 60m • Peak: 2 - 5hr

Regular-Novolin R

• Duration: 6 - 8hr

NPH-Humulin N

• Onset: 2 - 4hr • Peak: 5 - 12hr

NPH-Novolin N Detemir-Levemir

• Duration: 10 - 18hr • Onset: 1 - 2hr • Peak: None

Gargine-Lantus

• Duration: 20 - 24hr

Novolog Mix 70/30

• Onset: 10 - 30m • Peak: 1 - 6hr

Humalog Mix 70/25

• Duration: 18 - 20hr • Onset: 30m

NPH+ Regular 70/30

• Peak: 2 - 12hr • Duration: 10 - 16hr

Table 12-1

Chapter 12 - Hormonal

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