diabetes 2

Client Assessment for Type 1 Diabetes

• Discharge Planning: A nurse must assess the client’s ability to manage their diabetes before discharge.

• Monitor Blood Glucose Levels: Ensure the client is able to check their blood glucose levels independently and understand how to interpret the results.

Complications of Chronic Hyperglycemia

• Cellular Alterations: Chronic hyperglycemia causes irreversible cellular alterations and calcification due to poor perfusion.

• Diabetic Foot Problems Triad:

  • Neuropathy: Loss of sensation leading to injuries going unnoticed.

  • Ischemia: Reduced blood flow causing tissue damage.

  • Sepsis: Increased risk of infections in feet due to decreased immune response.

Diabetic Foot Care

• Absence of Pulses: Check for absence of pulses in lower extremities as an indicator of poor circulation.

• Signs of Poor Perfusion: Coolness and decreased sensation are significant indicators of complications.

• Footwear and Care:

  • Diabetic Shoes: Referral to specialized fittings for diabetic shoes is essential.

  • Avoid Hot/Cold Extremes: Educate clients on avoiding extreme temperatures; do not use heating pads or hot water bottles on feet.

  • Preventive Measures: Emphasize the importance of proper foot care to prevent injury.

Underlying Conditions and Risks

• Coronary Artery Disease: Higher incidence of myocardial infarction (MI) and cerebrovascular accidents (CVA) among diabetics due to:

  • Endothelial damage from high glucose levels, leading to atherosclerosis.

  • This condition further decreases perfusion to critical areas, including the heart and brain.

Insulin Management and Meal Planning

• Insulin Pumps: Understanding the conversion rate for insulin administration based on carbohydrate intake is crucial (1 unit for every 15g of carbs).

• Meal Planning:

  • Familiarity with various meal planning methods for diabetics is important.

  • Methods include carbohydrate counting and understanding glycemic index.

  • Stay informed about different diabetic meal plans outlined in educational materials.