Transcript 20. Interventions for Clients with Diabetes Mellitus I and Mellitus II

Interventions for
Clients with Diabetes
Mellitus
Types of Diabetes
Type I
Type 2
Gestational
Other types include:
Genetic defect beta cell or insulin
Disease of exocrine pancreas
Drug or chemical induced
Infections
Others
Absence of Insulin
Hyperglycemia
Polyuria
Polydipsia
Polyphagia
Hemoconcentration, hypervolemia,
hyperviscosity, hypoperfusion, and
hypoxia
Acidosis, Kussmaul respiration
Hypokalemia, hyperkalemia, or normal
Acute Complications of
Diabetes
Diabetic ketoacidosis
Hyperglycemic-hyperosmolarnonketotic syndrome
Hypoglycemia from too much
insulin or too little glucose
Chronic Complications of
Diabetes
Cardiovascular disease
Cerebrovascular disease
Retinopathy (vision) problems
Diabetic neuropathy
Diabetic nephropathy
Male erectile dysfunction
Assessment
History
Blood tests
Fasting blood glucose test: two tests >
126 mg/dL
Oral glucose tolerance test: blood glucose
> 200 mg/dL at 120 minutes
Glycosylated hemoglobin assays
Glucosylated serum proteins and albumin
Urine Tests
Urine testing for ketones
Urine testing for renal function
Urine testing for glucose
Risk for Injury Related to
Hyperglycemia
Interventions include:
Dietary interventions, blood glucose
monitoring, medications
Oral therapy
Sulfonylurea agents
Meglitinide analogues
Biguanides
Alpha-glucosidase inhibitors
Thiazolinedione antidiabetic agents
Drug Therapy
Drug administration
Drug selection
Insulin therapy:
Insulin analogue
Short-acting insulin
Concentrated insulin
Intermediate
(Continued)
Drug Therapy (Continued)
Fixed-combination
Long-acting
Buffered insulins
Insulin Regimens
Single daily injection protocol
Two-dose protocol
Three-dose protocol
Four-dose protocol
Combination therapy
Intensified therapy regimens
Pharmacokinetics of Insulin
Injection site
Absorption rate
Injection depth
Time of injection
Mixing insulins
Complications of Insulin
Therapy
Hypoglycemia
Lipoatrophy
Dawn phenomenon
Somagyi's phenomenon
Alternative Methods of Insulin
Administration
Continuous subcutaneous infusion
of insulin
Implanted insulin pumps
Injection devices
New technology includes:
Inhaled insulin
Transdermal patch (being tested)
Client Education
Storage and dose preparation
Syringes
Blood glucose monitoring
Interpretation of results
Frequency of testing
Blood glucose therapy goals
Diet Therapy
Goals of diet therapy
Principles of nutrition in diabetes
Protein, fats and carbohydrates, fiber,
sweeteners, fat replacers
Alcohol
Food labeling
Exchange system, carbohydrate counting
Special considerations for type 1 and
type 2 diabetes
Exercise Therapy
Benefits of exercise
Risks related to exercise
Screening before starting exercise
program
Guidelines for exercise
Exercise promotion
Whole-Pancreas
Transplantation
Operative procedure
Rejection management
Long-term effects
Complications
Islet cell transplantation hindered by
limited supply of beta cells and
problems caused by antirejection drugs
Wound Care
Wound environment
Debridement
Elimination of pressure on infected
area
Growth factors applied to wounds
Potential for Hypoglycemia
Blood glucose level < 70 mg/dL
Diet therapy: carbohydrate
replacement
Drug therapy: glucagon, 50% dextrose,
diazoxide, octreotide
Prevention strategies for:
Insulin excess
Deficient food intake
Exercise
Alcohol
Potential for Diabetic
Ketoacidosis
Interventions include:
Monitoring for manifestations
Assessment of airway, level of
consciousness, hydration status, blood
glucose level
Management of fluid and electrolytes
(Continued)
Potential for Diabetic
Ketoacidosis (Continued)
Drug therapy goal: to lower serum
glucose by 75 to 150 mg/dL/hr
Management of acidosis
Client education and prevention
Potential for HyperglycemicHyperosmolar Nonketotic
Syndrome and Coma
Interventions include:
Monitoring
Fluid therapy: to rehydrate the client and
restore normal blood glucose levels
within 36 to 72 hr
Continuing therapy with IV regular insulin
at 10 units/hr often needed to reduce
blood glucose levels