Diabetes Mellitus Management

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Diabetes Mellitus Management : 

Diabetes Mellitus Management Reynel Dan L. Galicinao

Diagnostic Evaluation : 

Diagnostic Evaluation FBS ≥ 126 mg/dL Random blood glucose ≥ 200 mg/dL with classic symptoms (polyuria, polydipsia, polyphagia, weight loss) OGTT ≥ 200 mg/dL on the 2-hour sample Tests for glucose control over time are glycated hemoglobin and fructosamine assay.

Diet : 

Diet Dietary control with caloric restriction of carbohydrates and saturated fats to maintain ideal body weight. The goal of meal planning is to control blood glucose and lipid levels. Weight reduction is a primary treatment for type 2 diabetes.

PRINCIPLE : 

PRINCIPLE Each meal should consist of a balance of carbohydrates, proteins, and fats. Consistency in timing of meals and amounts of food eaten on a day-to-day basis help regulate blood glucose levels. Increase the intake of soluble and insoluble fiber. Avoid salt whenever possible. Prepare foods to retain vitamins and minerals and reduce fats. Distribute snacks in the meal plan depending on insulin/medication regimens, physical activity, and lifestyle. Use alcohol only in moderation. Use alternative nonnutritive, noncaloric sweeteners in moderation.

Exercise : 

Exercise Regularly scheduled, moderate exercise performed for at least 30 minutes most days of the week promotes the utilization of carbohydrates, assists with weight control, enhances the action of insulin, and improves cardiovascular fitness.

Medications : 

Medications Second-Generation Sulfonylureas Glyburide (Micronase, DiaBeta) Glyburide, micronized (Glynase) Glipizide (Glucotrol) Glipizide (Glucotrol XL) Glimepiride (Amaryl) Biguanides Metformin (Glucophage) Metformin (Glucophage XR) Alpha-Glucosidase Inhibitors Acarbose (Precose) Miglitol (Glyset) Meglitinide Analogue Repaglinide (Prandin) Amino Acid Derivative Nateglinide (Starlix) Thiazolidinediones Rosiglitazone (Avandia) Pioglitazone (Actos) Combination Agents Glyburide/metformin (Glucovance) Glipizide/metformin (Metaglip) Rosiglitazone/metformin (Avandamet)

NURSING MANAGEMENT : 

NURSING MANAGEMENT

Nursing Interventions : 

Nursing Interventions Keep accurate records of vital signs, weight, fluid intake, urine output, and calorie intake. Monitor serum glucose and urine acetone levels. Monitor patient for acute complications of diabetes therapy, especially hypoglycemia (vagueness, slow cerebration, dizziness, weakness, pallor, tachycardia, diaphoresis, seizures, and coma). If the patient experiences a hypoglycemic episode, immediately give a carbohydrate in the form of fruit juice, hard candy, honey or, if the patient is unconscious, glucagon or I.V. dextrose.

Slide 9: 

Also, be alert for signs and symptoms of hyperosmolar coma (polyuria, thirst, neurologic abnormalities, and stupor); this hyperglycemic crisis requires I.V. fluids and insulin replacement. Monitor diabetic effects on the cardiovascular system (such as cerebrovascular, coronary artery, and peripheral vascular impairment) and on the peripheral and autonomic nervous systems. Provide meticulous skin care, especially to the feet and legs. Treat all injuries, cuts, and blisters.

Slide 10: 

Avoid constricting hose, slippers, or bed linens. Observe the patient for signs of urinary tract and vaginal infection. Encourage adequate fluid intake. Monitor the patient for signs and symptoms of diabetic neuropathy (numbness or pain in the hands and feet, footdrop, and neurogenic bladder). Consult a dietitian to plan a diet with the recommended allowances of calories, protein, carbohydrates, and fats, based on the patient's particular requirements.

Slide 11: 

Encourage the patient to verbalize feelings about diabetes and its effects on lifestyle and life expectancy. Offer emotional support and a realistic assessment of his condition. Stress that with proper treatment he can have a near-normal lifestyle and life expectancy. Help the patient develop coping strategies. Refer him and his family to a counselor, if necessary. Encourage them to join a support group.