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Diabetes Mellitus 2 (Risk factors (Race (Hispanic, Asian, South Asian,…
Diabetes Mellitus 2
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decreasing insulin production # #
Increasing insulin resistance # # # # #
Metabolic syndrome (Syndrome X) # # # # #
Treatment
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FPG preferred; every 3 years age 40+, more freq age <40
ASSESSMENT
Assessment
Subjective
Health History
- Mumps, Rubella, Viral infections (ex. coxsackievirus)
- Recent trauma, infection, stress
- Pregnancy, birth (>4 kg)
- Chronic pancreatitis
- Cushing’s syndrome, acromegaly
- Family history of DMI/II
- Obesity
Medications
- Compliance with insulin/OHA (oral hypoglycemic agents)
- Corticosteroids, diuretics, phenytoin
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Objective
Eyes
- Vitreal hemmorhage, cataracts
Integumentary
- Dry, warm, inelastic skin; pigmented lesions (legs); ulcers (feet); loss of hair on toes
Respiratory
- Rapid, deep respirations (Kussmaul)
Cardiovascular
- hypotension ; weak, rapid pulse (peripheral diminished); pale/cold feet
Gastrointestinal
- Dry mouth, vomiting, fruity breath
Neruological
- Altered reflex, restlessness, confusion, stupor, coma, reduced sensation/vibration (feet)
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Intervention
Surgery
- Modify medication treatment for before, during, and after
- Monitor hypoglycemia signs (sweating, tachycardia, tremors)
Ambulatory/home care
- Assess self-care activities affected (ability to prepare meal, self monitor BG, safely admin OHA, insulin injection techniques)
- Identify meaning to clients
- Support lifestyle modifications
- Involve client network
Insulin therapy/OHA
- Consider financial situation, cognitive status, eating habits, home environment, attitudes towards diabetes, medication history
- Understand interaction of insulin, diet, activity
- Recognize and manage symptoms of hypoglycemia
- Explore underlying fears before teaching
- Minimal injection rxns and SE
- Proper insulin/OHA preparation, storage, timing, admin techniques
Personal Hygeine
- Daily brushing/flossing (susceptible to periodontal disease)
- Foot care (wash, non abrasive/irritating aseptic ointment)
- Monitoring injuries (infection or no healing within 24hrs - call HCP immediately)
Medical identification and Travel
- Wear medical alert bracelet or necklace
- Appropriate planning (best with consultation of HCP) - account for time zone changes, delays/closures, equipment, customs, etc.
Client/Family Teaching
- Enables client participation in their own care
- Match level of self management with client abilities
Barriers
- Inadequacy of abilities
- Unwillingness to change behaviours
- Ineffective coping strategies
- Lack of resources
- Cognitive deficits
Guidelines
Disease process
- pancreas, b cells, insulin production, insulin-glucose relationship
Physical activity
- management of BG, improve CV function and general health
Menu Planning
- well-balanced, impact of carbohydrates on glycemic index and BG
Medication Compliance
- Proper use of insulin and OHA, account for physical limitations/inability to admin, discuss SE and safety issues
Monitoring Blood Glucose
- How to correctly read, when BG should be checked, how to record, how to adjust insulin
Risk Reduction
- Ensure understanding and responses to S&S of hypo/hyperglycemia
- Importance of proper foot care, regular eye examinations, consistent glucose monitoring
- Effects of stress on blood glucose
Psychosocial
- Resources available to facilitate adjustment and answer qs about living with condition, especially long term
Acute illness
- ↑ management, insulin, fluids (noncarbohydrates)
- ↓ rise in blood glucose by counterregulatory hormone responses
Evaluation
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Key elements of the therapeutic regimen, including knowledge of the disease and treatment plan
Balance of nutrition, activity, and insulin availability that results in normal BG and optimum weight
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Onset
DIAGNOSIS
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Casual plasma glucose ≥ 11.1 mmol/L + diabetes symptoms # # #
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PATHOPHYS
Insulin deficiency
↑ Hepatic glucose output
Hyperglycemia
Glucosuria
Osmotic diuresis
Polyuria
Dehydration
↓ Blood volume
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Cellular shrinking
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↓ Glucose uptake by cells #
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