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Type II Diabetes 8-18-20 - Coggle Diagram
Type II Diabetes 8-18-20
Pathophysiology
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Type II diabetes occurs when the cells in the body do not respond normally to insulin, making the body insulin resistance.
Nursing Interventions:
Assess for signs of hyperglycemia. Hyperglycemia results when there is an inadequate amount of insulin to glucose. Excess glucose in the blood creates an osmotic effect that results in increased thirst, hunger, and increased urination. The patient may also report nonspecific symptoms of fatigue and blurred vision.
Assess the pattern of physical activity. Physical activity helps lower blood glucose levels. Regular exercise is a core part of diabetes management and reduces risk for cardiovascular complications.
Assess the patient’s current knowledge and understanding about the prescribed diet. Nonadherence to dietary guidelines can result in hyperglycemia. An individualized diet plan is recommended.
Monitor the patient’s HbA1c-glycosylated hemoglobin. This is a measure of blood glucose over the previous 2 to 3 months. A level of 6.5% to 7% is desirable.
Assess for anxiety, tremors, and slurring of speech. Treat hypoglycemia with 50% dextrose. These are signs of hypoglycemia and D50 is the treatment for it.
Assess feet for temperature, pulses, color, and sensation. To monitor peripheral perfusion and neuropathy.
Assess blood glucose levels before meals and at bedtime. Blood glucose should be between 140 to 180 mg/dL. Non-intensive care patients should be maintained at pre-meal levels <140 mg/dL.
Monitor urine albumin to serum creatinine for renal failure. Renal failure causes creatinine >1.5 mg/dL. Microalbuminuria is the first sign of diabetic nephropathy.
Teach patient how to perform home glucose monitoring. Blood glucose is monitored before meals and at bedtime. Glucose values are used to adjust insulin doses.
Report BP of more than 160 mm Hg (systolic). Administer hypertensive as prescribed. Hypertension is commonly associated with diabetes. Control of BP prevents coronary artery disease, stroke, retinopathy, and nephropathy.
Instruct patient to avoid heating pads and always to wear shoes when walking. Patients have decreased sensation in the extremities due to peripheral neuropathy.
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Important Assessments
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Fasting plasma glucose. This is also known as a fasting blood sugar test. It measures your blood sugar on an empty stomach. You won't be able to eat or drink anything except water for 8 hours before the test.
Oral glucose tolerance test (OGTT). This checks your blood glucose before and 2 hours after you drink something sweet to see how your body handles the sugar.
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Medications:
Metformin (Fortamet, Glucophage, Glumetza, Riomet). This is usually the first medication used to treat type 2 diabetes. It lowers the amount of glucose your liver makes and helps your body respond better to the insulin it does make.
Sulfonylureas. This group of drugs helps your body make more insulin. They include glimepiride (Amaryl), glipizide (Glucotrol, Metaglip), and glyburide (DiaBeta, Micronase).
Meglitinides. They help your body make more insulin, and they work faster than sulfonylureas. You might take nateglinide (Starlix) or repaglinide (Prandin).
Thiazolidinediones. Like metformin, they make you more sensitive to insulin. You could get pioglitazone (Actos) or rosiglitazone (Avandia). But they also raise your risk of heart problems, so they aren’t usually a first choice for treatment.
DPP-4 inhibitors. These medications -- linagliptin (Tradjenta), saxagliptin (Onglyza), and sitagliptin (Januvia) -- help lower your blood sugar levels, but they can also cause joint pain and could inflame your pancreas.
GLP-1 receptor agonists. You take these medications with a needle to slow digestion and lower blood sugar levels. Some of the most common ones are exenatide (Byetta, Bydureon), liraglutide (Victoza), and semaglutide (Ozempic).
SGLT2 inhibitors. These help your kidneys filter out more glucose. You might get canagliflozin (Invokana), dapagliflozin (Farxiga), or empagliflozin (Jardiance).
Insulin. You might take long-lasting shots at night, such as insulin detemir (Levemir) or insulin glargine (Lantus).