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Diabetes Mellitus 🍬 - Coggle Diagram

- - - - Abdominal pain
- - - - Better blood glucose regulation
      - Lowered insulin requirements (in type I)
      - Increased insulin sensitivity
      - Weight loss
      - Decreased risk for cardiovascular disease by lowering most lipid levels and raising HDL (the “good” cholesterol)
      - Decreased BP
      - Improved cardiovascular function
      - Prevents or delays type II DM
    - - Based on individual health 🧡
      - 150 min/week ⌚
      - Test 🩸
      - Monitor ketones 🚰
      - Inspect feet 🦶
      - Good kicks 👟
      - No exercise within 1 hr or peak action 💉
    - - 80 - < 250 mg/dL 🩸🍨
      - If high intensity or 1 hr w/o meal, consume a carb snack 🍘
      - Keep a simple sugar handy 🍫
      - Medical Alert Bracelet ⚠️
      - SAFETY 🛟
        
        Type 1 keep levels 100 - 250 mg/dL 🩸 + no ketones
        
        Monitor frequently over next 24 hours ⌛
  - - - Metformin 💊
        
        Expected Actions 🎬
        
        ⬇️ absorption of glucose in intestines
        
        ⬇️ synthesis of glucose by liver
        
        ⬆️ insulin sensitivity
        
        Adverse Reactions 👎
        
        Nausea + Vomiting 🤢
        
        💦 Diarrhea
        
        Metallic taste 🪙
        
        Decreased B12 + folic acid (monitor) 🩸
        
        😪 Lactic acidosis
        
        Nursing Interventions 🩺
        
        Monitor for signs of lactic acidosis (remember s/s of DKA, hyperglycemia) 😪
        
        🚫Discontinue therapy if lactic acidosis develops
        
        Monitor I + O’s 💧
        
        Monitor lab values (BMP, BUN, creatinine, B12, folic acid) 🩸
        
        Do NOT drink alcohol (reduces risk of lactic acidosis) 🚫🍺
        
        ⚠️ HIGH YIELD: Discontinue 1 - 2 days before and 48 hours after any imaging tests requiring IV contrast media or surgery to prevent renal damage and lactic acidosis
        
        Administration 💊
        
        PO: BID w/meals (morning + evening)
        
        XR: PO 1x daily with evening meal (do NOT crush or chew) ⭐
        
        Client Education 📚
        
        Avoid alcohol 🚫🍺
        
        Report any signs of lactic acidosis and stop medication 📞
        
        📜 Review signs of hypo- and hyperglycemia with patient
        
        Explain that metformin is to control, not cure diabetes
        
        Teach home management of hypoglycemia 🏡
        
        Contraindications/Precautions ⚠️
        
        Hypoxic states (acute HF, shock, MI) 🫀
        
        🦠 Severe infection (sepsis)
        
        Chronic alcohol abuse 🥃🚬
    - - Lispro (Rapid-Acting)
      - Regular human insulin (Short-acting)
      - NPH (intermediate-acting)
      - Glargine (Long-acting)
- - - - 15 g of fast-acting carbs
        
        1/2 cup (120 mL) of fruit juice 🍊
        
        1/2 cup (120 mL) of regular (non-diet) soft drink 🥤
        
        8 oz (240 mL) of skim milk 🥛
        
        6 - 10 hard candies 🍬
        
        4 cubes of sugar 🍦
        
        4 tsp of sugar 🥄
        
        6 saltines 🍘
        
        3 graham crackers
        
        1 tbsp (15 mL) of honey or syrup 🍯
      - Wait 15 ins and recheck blood glucose
      - 15 g more of carbs if glucose is < 70 mg/dL
    - - 💉 Administer 1 mg of glucagon via IM or SC
      - ⏲️Administer second dose if patient remains unconscious after 10 minutes
      - 📞 Notify primary health provider or Call 911 and follow instructions
  - - - Moderate to large urine ketones 🫠
      - 📈 Elevated glucose that doesn’t resolve with treatment
      - High temp > 101.5 F (38.6 C) 🌡️
      - Persistent N/V + diarrhea 🤢🚽
- - - - Glucagon
    - - Insulin 🔑
  - - - NO insulin present!
      - Lifelong insulin therapy
    - - Progressive
      - insulin resistance
      - Metabolic Syndrome
        
        HTN 🫀
        
        ⬇️ HDL
        
        ⬆️ triglycerides
        
        ⬆️ fasting glucose
        
        Waist circumference 👖
    - - Acute
        
        DKA
        
        HHS
        
        Hypoglycemia
      - Chronic
        
        Macrovascular
        
        Cardiovascular disease (CAD, PAD, PVD) 🫀
        
        Cerebrovascular disease (stroke) 🧠
        
        Reduced Immunity 🤒
        
        Microvascular
        
        Nephropathy 🫘
        
        Neuropathy 🧠
        
        Retinopathy 👁️