Health Alterations class 12: Glucose Regulation

Signs of hypoglycemia

1. Blood sugar under 4

2. Reduced cognition

3. Tremors

4. Diaphoresis

5. Weakness

6. Hunger

7. Irritability

8. Seizure

Signs of hyperglycaemia

1. Blood sugar over 7

2. Polyuria

3. Polydipsia

4. Dehydration

5. Fatigue

6. Fruity odor to breath

7. Kussmauls respirations

8. Weight loss

9. Hunger

10. Poor wound healing

Normal blood sugar

4-6

Diabetes mellitus

Multisystem disease, abnormal insulin production or impaired insulin utilization

Classifications of diabetes

1. Type 1

2. Prediabetes (impaired glucose tolerance and elevated fasting glucose but no classic symptoms)

3. Type 2

4. Secondary (associated with other diseases/meds, goes away once cause is removed)

5. Gestational diabetes (hormones from placenta make cells insulin resistant, resolved with delivery, increased risk of T2DM in the future)

Type 1 diabetes mellitus

1. 10% of diabetes patients

2. Genetic predisposition or exposure to virus

3. Pancreatic beta cells are destroyed

4. Onset any age, usually before 30

5. Thin (history of sudden weight loss) and classic symptoms

6. Acute onset of symptoms (pancreas can no longer produce insulin)

7. Require insulin

Type 2 diabetes mellitus

1. 90% of patients with diabetes

2. Insulin resistance (tissues don’t respond to action of insulin)

3. Older than 35

4. Obese, family history, HTN, increased cholesterol

5. Slow, gradual

6. Diet and exercise

7. Oral hypoglycemic agents and insulin

8. Beta cells lose function

Signs and symptoms of diabetes

1. Polyuria

2. Polydipsia

3. Polyphagia (increased appetite)

4. Weight loss

5. Weakness, fatigue

6. T2DM: non specific, fatigue, recurrent infections, prolonged wound healing, visual, painful peripheral neuropathy in feet

Diagnosis of diabetes

1. History and physical (increased BP, EKG, blood tests (lipids), urines)

2. Glycated hemoglobin (A1C >6.5%) long term measure of blood sugar, 120 days (life span of RBC)

3. Fasting blood glucose (>7 mmol)

4. 2 hour plasma glucose level in a 75g oral glucose tolerance test (>11.1 mmol/l)

HBA1C goal for type 1 DM

Less than 7%

HBA1C goal in type 2 DM

Less than 6.5%

Nursing care of diabetes

1. Goal is to maintains blood glucose levels near normal and or event complications

2. Nutrition

3. Exercise

4. Self monitoring of blood glucose

5. Medications

Insulin

1-4 injections/day (abdomen, tricep, lower back/butt, thigh)

Preferred insulin injection site

Abdomen

Insulin complications

1. Allergic reaction (rare)

2. Lipodystrophy-rotate injection sites

3. Somolgyi effect (low blood glucose during sleep and rebound hyperglycemia)

How to prevent the somolgyi effect

Check insulin around 2-4 am and adjust hs insulin

Optimal nutrition for diabetes

1. Protein 15-20% of energy

2. Carbs 45-60% of energy

3. Fat less than 35% of energy and no more than 9% from saturated fats

4. Fibre 30-50 grams/day

Alcohol and diabetes

Alcohol is high calorie with no nutritional value. Causes hypoglycemia (inhibits glucose production by liver), so consume food with alcohol

Glycemic index

How much food increases glucose

Foods with High GI

Cause a sharp rise in blood glucose. Foods such as potatoes and white bread, enjoy in moderation

Foods with low GI

Steadily increase glucose over longer time. Foods such as brown rice

Carb counting

Carbs minus fibre (fibre doesn’t raise blood glucose)

Diabetes and exercise

1. Lowers blood sugar (may need a snack before exercising, may need to adjust insulin)

2. 150 minutes/week

3. Slow, gradual increase in exercise (3 times/week)

4. Aids in weight loss

5. Lowers cardiovascular risk

Self monitoring blood glucose for type 1

At least 3 times a day

Self monitoring blood glucose for type 2

At least once a day

Self monitoring blood glucose when ill

At least every 4 hours

What must patients have in order to self monitor their blood glucose

1. Visual acuity

2. Fine motor coordination

3. Cognitive ability

4. Comfort with technology

Benefits of SMGB

1. Helps normalize glucose

2. Patients can make self management decisions

3. Reduces long term complications (helps detect issues early)

Education for self management

1. How to check blood glucose

2. Diligent skin and dental hygiene (regular dental visits and daily skin/feet assessment)

3. Medical ID such as med alert bracket at all times

4. Supplies at all times (meds, glucometer, snacks that are fast acting carbs)

Acute illness/surgery with diabetes

Can increase blood sugar, check q4 and take meds

If pt with diabetes is NPO for surgery

IV fluids with dextrose, insulin and adjustments to regular dosing

Metformin and procedures

Hold metformin before procedures involving contrast medium

What meds should not be taken if ill and dehydrated

If vomiting and diarrhea occurs do not take suphonylureas, metformin or SGLT2 inhibitors

Sickness and insulin

Do not hold insulin when sick (glucose increases when sick or stressed)

How to rehydrate with diabetes and illness

Water, bone broth, diet soft drinks

What meds should be held when sick

SADMANS (sulfonylureas, ACE inhibitors, diuretics, metformin, Angiotensin receptor blockers, NSAIDS, SGLTZ inhibitors) restart when eating/drinking normally