treatment of dm (reivew)

Focus on Diabetes Mellitus:

Focus on Diabetes Mellitus ~Chapter 41~ Medical-Surgical Nursing 1

Treatment Goal Is to Normalize Blood Glucose Levels:

Treatment Goal Is to Normalize Blood Glucose Levels Intensive control dramatically decreases vascular and neuropathic complications

Dietary Management—Goals:

Dietary Management—Goals Provide optimal nutrition including all essential food constituents Meet energy needs Achieve and maintain a reasonable weight Prevent wide fluctuations of blood glucose levels Decrease serum lipids, if elevated

Role of the Nurse:

Role of the Nurse Be knowledgeable about dietary management Communicate important information to the dietician or other management specialists Reinforce patient understanding Support dietary and lifestyle changes

Meal Planning:

Meal Planning Consider food preferences, lifestyle, usual eating times, and cultural/ethnic background Review diet history and need for weight loss, gain, or maintenance Consider caloric requirements and calorie distribution throughout the day Carbohydrates: 50% to 60% carbohydrates, emphasize whole grains Fat: 20% to 30%, with >10% from saturated fat and >300 mg cholesterol Fiber Provide exchange lists

Glycemic Index:

Glycemic Index Describes how much a food increases blood glucose Combining starchy food with protein- and fat-containing food slows absorption and glycemic response Raw or whole foods tend to have lower response than cooked, chopped, or pureed foods Eating whole fruits rather than juices decreases the glycemic response due to fiber-slowing absorption Adding food with sugars may produce lower response if eaten with foods that are more slowly absorbed

Other Dietary Concerns:

Other Dietary Concerns Alcohol Nutritive and non-nutritive sweeteners Reading labels

Exercise:

Exercise Lowers blood sugar Aids in weight loss Lowers cardiovascular risk

Exercise Precautions:

Exercise Precautions Exercise when blood sugar levels are elevated (above 250 mg/dL) and ketones are present in urine should be avoided Insulin normally decreases with exercise; patients on exogenous insulin should eat a 15-g carbohydrate snack before moderate exercise to prevent hypoglycemia If exercising to control or reduce weight, insulin must be adjusted Potential exists for postexercise hypoglycemia Need to monitor blood glucose levels

Exercise Recommendations:

Exercise Recommendations Encourage regular daily exercise Gradual increase in exercise period is encouraged Modify exercise regimen to patient needs and presence of diabetic complications or potential cardiovascular problems Conduct exercise stress test for patients older than age 30 who have 2 or more risk factors is recommended Gerontologic considerations

Insulin Therapy:

Insulin Therapy Blood glucose monitoring Categories of insulin: see Tables 41-3 Rapid-acting Short-acting Intermediate-acting Very long-acting Inhaled insulin

Oral Antidiabetic Agents:

Oral Antidiabetic Agents Used for patients with type 2 diabetes who cannot be treated with diet and exercise alone Combinations of oral drugs may be used Major side effects: hypoglycemia Nursing interventions: monitor blood glucose and assess for hypoglycemia and other potential side effects Patient teaching See Table 41-6