diabetes

aerobic exercise

30 minutes of moderate-to-vigorous intensity aerobic exercise at least 5 days a week. Spread activity out over at least 3 days during the week and try not to go more than 2 days in a row without exercising. aerobic exercise and stregthening exercise recommended by ADA. walking is as beneficial as running

prevent hypoglycemia

Check blood glucose levels Eat regular meals and snacks Be physically active

type 2 diabetes overview

The far more common type 2 diabetes occurs when the body becomes resistant to insulin or doesn't make enough insulin. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases.

diabetic rates amount each culture

The rates of DM in non-Hispanic whites 7.1%, Asian Americans 8.4%, Hispanics 11.8% non-Hispanic blacks 12.6%

bracelet for hypoglycemia

diabetic bracelet states: if unconsciosus/ abnormal behavior. if can swallow give sweet drink, OJ, lifesavers, low fat milk if not recovery call Dr/ send to hospital if unconscious NPO. call 911

microvascular disease

diabetic retinopathy: non poliferative proliferative macular oedema microalbuminuria macroalbuminuria end stage renal disease erectile dysfunction autonomic neuropathy peripheral neuropathy osteomyelitis amputation

short acting

regular (humulin R, Novolin R) onset: 30min- 1 hour peak: 2-5 hours duration: 5-8 hours

random blood sugar test

Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of last meal, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes

type 2 nutritional management

prevent hyperglycemia It is essential to assist patient to lose weight and maintain appropriate weight Maintain near normal blood sugar

insulin syringes

2 sizes: ½ ml - 50 units or less (low-dose) 1 ml - up to 100 units (standard) Insulin is administered subcutaneous in specifically designated insulin syringes i.e. orange top. Do not use 1 ml or 3 ml syringes Do not use other drugs in insulin syringes.

fasting blood sugar test

A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, indicative of diabetes.

hyperglycemia manifestations

Elevated blood glucose level, 3 P's (Note: polyphagia initially then loss of appetite),weakness, fatigue, blurred vison, H/A, glycosuria, N/V, progression to DKA

hypoglycemia treatment

Follow the rule of 15 (see p. 1179-Lewis) See Table 49.19 for treatment of hypoglycemia patients who can tolerate oral intake, 15 g of rapidly digested carbohydrates (such as 4 oz. of fruit juice or regular soda, one tube of glucose paste, or four glucose tablets) are recommended. In patients who are NPO or can't take oral treatment, dextrose 50% I.V. or glucagon given I.M. or subcutaneously are appropriate treatments.

treating severe hypoglycemia

Glucagon injection is given in the presence of severe hypoglycemia. An injection of glucagon will quickly raise the blood glucose level. Glucagon emergency kits prescribed to newly diagnosed patients. If the patient is likely to have severe hypoglycemia, instruct the patient to teach his/her family, friends, and coworkers when and how to give you a glucagon injection. Also, to tell family, friends, and coworkers to call 911 right away after giving a glucagon injection or if the patient does not have a glucagon emergency kit. tell patient to wear a bracelet

role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: food and your liver. Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin. The liver stores glucose as glycogen. When glucose levels are low, the liver converts stored glycogen into glucose to keep your glucose level within a normal range.

stem cell transplant

In a 2007 study, a small number of people newly diagnosed with type 1 diabetes were able to stop using insulin for up to five years after being treated with stem cells made from their own blood.

insulin administration

Insulin cannot be taken orally to lower blood sugar because stomach enzymes interfere with insulin's action. Therefore, it must be given either through injections or an insulin pump. Need a mixture of insulin types to use throughout the day and night. Multiple daily injections that include a combination of a long-acting insulin, such as Lantus or Levemir combined with a rapid-acting insulin, such as Apidra, Humolog or Novolog, more closely mimic the body's normal use of insulin. Three or more insulin injections a day has been shown to improve blood sugar levels, due to eating insulin pump or sometimes insulin drip

type 2 insulin therapy

May be used in the hospital setting in addition to oral medications May become a part of the therapeutic management of the disease in about 50% of these individuals may not need insulin injections. can be controlled with diet, exercise and controlling sugar

intermediate acting

NPH (humulin N, Novolin N) onset: 1.5 hours-4 hours peak: 4-12 hours duration: 12-18 hours

islet cell transplantation

Researchers are experimenting with islet cell transplantation, which provides new insulin-producing cells from a donor pancreas.

symptoms of type 2 diabetes

Onset is gradual over a period of many years and most often there are few, if any, symptoms. Often discovered w/routine lab testing or when undergoing treatment for other conditions. may exhibit: polyuria, polydispia, and polyphagia Fatigue Blurred vision Slow-healing sores or frequent infections. Areas of darkened skin (acanthosis nigricans)

innaccurate results result from glucose monitoring

Poor technique is used while obtaining blood sample If patient's hematocrit is <25% or >60% If patient is severely dehydrated. If site is poorly perfused i.e. severe PVD if get 600 result, check another finger and verify if its truly that high hematocrit low due to hemorrhage hematocrit high due to dehydration, blood very concentrated

hyperglycemia treatment

Seek medical care. Continue meds as ordered. Check blood glucose levels and record. Drink fluids at least on an hourly basis.

strengthening exercise

Strength training (also called resistance training) makes the body more sensitive to insulin and can lower blood glucose. It helps to maintain and build strong muscles and bones, reducing risk for osteoporosis and bone fractures. The more muscle you have, the more calories you burn - even when your body is at rest. go more in depth with exercise Example: start by taking a walk outside 5 minutes then increase time

glycated hemoglobin A1C test

This blood test indicates your average blood sugar level for the past two to three months. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. lets the doctors know if sugar has been high for a long time

Incidence

Total: 29.1 million people or 9.3% of the population have diabetes. Diagnosed: 21.0 million people. Undiagnosed: 8.1 million people (27.8% of people with diabetes are undiagnosed). Eighty-six million Americans now have prediabetes—that's 1 out of 3 adults! Of those 86 million, 9 out of 10 of them do not even know they have it. Without intervention, 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years

Risk factors for type 2

Weight-primary risk factor for type 2 diabetes Fat distribution Inactivity Family history Race Age (over 45) Prediabetes Gestational diabetes: higher risk for devloping later Polycystic ovarian syndrome

exercise recommnedations

aerobic exercise: Brisk walking (outside or inside on a treadmill) Bicycling/Stationary cycling indoors Dancing Low-impact aerobics Swimming or water aerobics Playing tennis Stair climbing Jogging/Running Hiking Rowing Ice-skating or roller-skating Cross-country skiing Moderate-to-heavy gardening strength training: Weight machines or free weights at the gym Using resistance bands Lifting light weights or objects like canned goods or water bottles at home Calisthenics or exercises that use your own body weight to work your muscles (examples are pushups, sit ups, squats, lunges, wall-sits and planks) Classes that involve strength training Other activities that build and keep muscle like heavy gardening

macrovascular complication

affects the large blood vessels Coronary Artery Disease (CAD) Peripheral Artery Disease (PAD,PVD) Stroke

microvascular complications

affects the small bloos vessesl Nephropathy: kidneys (kidney failure can occur) Neuropathy: nerves ( can have tingling, if not taken care of will need amputation) Retinopathy: eyes (can become blind)

type 2 basic info age of onset type of onset prevalence environental factors primary defects islet cell antibodies ketosis

age of onset: usually age 35 up. more kids now have type of onset: insidious, no symptoms prevalence: 90-95% environmental factors: obseity, lack of exercise primary defects: insulin resistance, decreased insulin islet cell antibodies: absent ketosis: resistant except during infection or stress

hypoglycemia

can diagnose under 70 low blood glucose or low blood sugar, occurs when the level of glucose in your blood drops below normal. For many people with diabetes, that means a level of 70 milligrams per deciliter (mg/dL) or less.

bolus insulins

either rapid-acting (insulin lispro, insulin aspart, or insulin glulisine) or short-acting (regular insulin), are used to control both postprandial glucose rises and hyperglycemia. Rapid-acting insulins generally are preferred becauseof their fast onset, earlier peak to better cover postprandial glucose increases, and shorter duration, which avoids overlapping insulin doses when given at every meal. Optimal rapid-acting insulin scales have an order for an insulin dose that covers food eaten, plus a correction dose that covers hyperglycemia. However, rapid-acting insulin scales commonly are ordered as a "correction" for hyperglycemia. Rapid-acting insulins more closely mimic normal physiologic prandial insulin release than regular insulin, which has a slower onset, later peak, and longer duration (about 6 hours or more). The longer duration of regular insulin means that if it's given every 4 hours, it overlaps, causing insulin "stacking" and increasing the hypoglycemia risk. Also, the insulin dosage in a typical regular "sliding-scale" insulin regimen is based only on the BG level and is the same whether the patient eats a meal or is on NPO status. (See Timing is everything by clicking the PDF icon above.)

oral glucose tolerance test

fast overnight, and the fasting blood sugar level is measured. A sugary liquid is consumed, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate diabetes. 2 hour test for normal people 3 hours for pregnant person

long acting

glargine (lantus) 2 hours no peak. lasts 20-24 hours detemir (levemir) 1 hour no peak. lasts 6-24 hours onset: 0.8-4 hours peak: no pronounced peak duration: 24 plus hours CAN NOT MIX WITH OTHER INSULINS!!!!!!

hyperglycemia

is the technical term for high blood glucose . High blood glucose happens when the body has too little insulin or when the body cannot use insulin properly. The signs and symptoms include the following: High blood glucose (see below) High levels of sugar in the urine Frequent urination: no burning when pee, no UTI Increased thirst Hyperglycemia does not cause symptoms until glucose values are significantly elevated — above 200 milligrams per deciliter (mg/dL). in type 1 can lead to diabetic ketoacidosis

diabetes goal

is to keep blood sugar levels at normal or near-normal levels. Careful control of blood sugars can help prevent the long-term effects of poorly controlled blood sugar (diabetic complications of the eye, kidney, nervous system, and cardiovascular system)

insulin pump

is very expensive insulin driven change site 2-3 days. little needle that has a cathater that stays under the skin. remove tape when showering, pump usually found in the stomach. small pumps

rapid acting

lispro (humalog) aspart (NovoLog) glulisine (apidra) onset: 10-30 minutes peak: 30 min- 3 hours duration: 3-5 hours

carbs per meal and snack

meal 45-60 grams per carbs per snack 15-20 grams carbs per snack

clear insulin

Rapid-acting: Insulin aspart (NovoLog) Insulin lispro (Humalog) Short Acting: Regular ® (Humulin R, Novolin R) Long acting: Lantus (insulin glargine) Levemir (insulin detemir) NEVER MIX LONG ACTING WITH ANY OTHER INSULUN

treatment for type 2 diabetes

oral agents and insulin. Oral agents used if diet and exercise alone do not control hyperglycemia Administered 30 minutes prior to a meal. May be daily, BID or TID if not NPO insulin can be long/ short acting

blood glucose monitoring steps

1. Verify correct patient using two identifiers, enter medical record number into machine. 2. Alcohol Prep site (never use finger tip) let air dry. (Pt just washes hands at home). use side of finger 3. Push test strip into machine. 4. Lance site, wipe away first drop or as per policy, apply test strip to bead of blood in order to wick blood into strip 5. Results appear in approximately 30 seconds, record

type 1 basic info age of onset type of onset prevalence environental factors primary defects islet cell antibodies ketosis

Age at onset: more common young, can occur at any age type of onset abrupt, confused, unconscious prevalence: 5-10% environmental factors: virus, toxins primary defects: absent or minimal insulin production islet cell antibiodies: often present on onset ketosis: prone at onset. if patient is high in ketones they are in starvation islet cell antibodies mode

hypoglycemia causes

Alcohol intake without food, too little food-delayed, omitted or inadequate intake, too much diabetic medication, too much exercise without adequate food intake, Diabetic meds taken at the wrong time, loss of weight without change in meds, use of beta-adrenergic blockers interfering with recognition of symptoms

storage of insulin

Although manufacturers recommend storing insulin in the refrigerator, injecting cold insulin can sometimes make the injection more painful. To avoid this, many hospitals store the bottle of insulin at room temperature. Insulin kept at room temperature will last approximately 1 month. Do not store insulin near extreme heat or extreme cold. Never store insulin in the freezer, direct sunlight, or in the glove compartment of a car. Check the expiration date before using, and do not use any insulin beyond its expiration date. Examine the bottle closely to make sure the insulin looks normal: Regular insulin, check for particles or discoloration of the insulin. NPH or Lente, check for "frosting" or crystals in the insulin on the inside of the bottle or for small particles or clumps in the insulin.

combining 2 types of insulin

Always draw up clear (Regular) before cloudy (NPH) REMEMBER "R" before "N"; RN Determine total number of units to be drawn up and do not exceed ordered dose 1. wash hands 2. gently rotate NPH insulin bottle 3. wipe off tops of insulin vials with alcohol 4. draw back amount of air into the syringe that equals the total amount of insulin 5. inject air needed into NPH vial then remove 6. inject air needed into regular 7. invert regular insulin and remove needed dose 7. do not add more air, carefully removed dose from NPH vail that equals total

symptoms of type 1 diabetes

Classic triad- 3 P's Polydipsia-abnormally great thirst Polyuria-production of large volumes of dilute urine, frequent urination Polyphagia-extreme hunger Unintended weight loss Bedwetting in children who previously did not wet the bed during the night Irritability and other mood changes Fatigue and weakness Blurred vision In females, a vaginal yeast infection

treatment for type 1 diabetes

Anyone who has type 1 diabetes needs lifelong insulin therapy. Types of insulin are many and include: Rapid-acting insulin Long-acting insulin Intermediate options Examples are regular insulin (Humulin 70/30, Novolin 70/30, others), insulin isophane (Humulin N, Novolin N), insulin glulisine (Apidra), insulin lispro (Humalog) and insulin aspart (Novolog). Long-acting insulins include glargine (Lantus) and detemir (Levemir).

hypoglycemia manifestation

Blood glucose <70 mg/dL, cold, clammy skin, numbness of fingers toes, mouth, rapid heartbeat, emotional changes, H/A, nervousness, tremors, faintness, dizziness, unsteady gait, slurred speech, hunger changes in vision, seizures coma

which cultures have highest rates of diabetes

Certain ethnic and cultural groups, such as Hispanics, Native Americans, and African Americans, have a high incidence of diabetes. The increased prevalence can be attributed to genetic predisposition, environmental factors, and dietary choices. The highest incidence of diabetes is among Native Americans Pima Indians in Arizona have the highest rates in the WORLD (50% of adults have diabetes!)

treat hypoglycemia

Check blood glucose level w/onset of symptoms If the blood glucose level is below the target or less than 70, eat or drink 15 grams of carbohydrates right away. Examples include four glucose tablets or one tube of glucose gel 1/2 cup (4 ounces) of fruit juice—not low-calorie or reduced sugar* 1/2 can (4 to 6 ounces) of soda—not low-calorie or reduced sugar 1 tablespoon of sugar, honey, or corn syrup 2 tablespoons of raisins 120 ml is enough of sugar load- 15 grams. can give juice or sugar packet

risk factors for type 1 diabetes

Family history Genetics Geography Age- The first peak occurs between 4 and 7 years old, second peak is in children between 10 and 14 years old Risk factors not yet proven: Exposure to certain viruses, such as the Epstein-Barr virus, Coxsackie virus, mumps virus and cytomegalovirus Early exposure to cow's milk Low vitamin D levels Being born with jaundice

hyperglycemia causes

Illness, infection, corticosteroids, too much food, too little or no diabetes medication, inactivity, emotional or physical stress might have a loss in appetite Stress hyperglycemia in the hospital is illness-related and usually transient, with BG levels normalizing once the patient's other illness resolves.

role of insulin

Insulin is a hormone that comes from the pancreas. The pancreas secretes insulin into the bloodstream. Insulin circulates, enabling sugar to enter the cells. Insulin lowers the amount of sugar in the bloodstream. As blood sugar level drops, so does the secretion of insulin from the pancreas.

insulin sliding scale

Insulin lispro (Humalog) 15 min before or immediately after meal 3 units if glucose 150 - 200 6 units if glucose 201 - 250 9 units if glucose 251 - 300 12 units if glucose 351 - 400 15 units if glucose >400, call MD Subcutaneous before meals and at bedtime, notify MD if glucose < 70, Notify MD if glucose >400 Note: Insulin aspart (NovoLog) is commonly used as well for SS in the hospital (given 5-10 min before meal)

contributing factors for hypoglycemia

Insulin or diabetes medicines that increase the amount of insulin the body makes—but don't match the medications with the persons food or physical activity, hypoglycemia may develop. The following factors can make hypoglycemia more likely: Not eating enough carbohydrates Skipping or delaying a meal Increased physical activity Drinking too much alcohol without enough food Being sick

type 1 diabetes overview

Insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy.

Cloudy- NPH insulin

Intermediate Acting - 2-4 hr., peak 4-12 hrs., lasts 12-18 hrs. Humulin N Novolin N ReliOn N Combination Many different types Examples: Humalog 70/30, 70/25, 75/25, 50/50/70/30 roll vial between hands to mix insulin

type 1 nutritional management

Is essential to prevent hypoglycemia Emphasis is placed on meal planning and in the timing of meals and snacks to prevent fluctuation in blood glucose

rapid acting insulin (insulin administration)

Pumps are programmed to dispense specific amounts of rapid-acting insulin automatically. This steady dose of insulin is known as the basal rate. When a person eats, he/she programs the pump with the amount of carbohydrates and the current blood sugar, and the pump will give what's called a "bolus" dose of insulin to cover the meal and to correct the blood sugar if it's elevated. Some research has found that in some people an insulin pump can be more effective at controlling blood sugar levels than injections. has to program pump by what eaten check sugar 4 times a day

foods containing carbs

Starchy foods, sugars, fruits, milk, and yogurt are mostly carbs. These foods affect blood glucose much more than other foods, such as meat and meat substitutes, vegetables, or fats. berries are lowest glycemic index fruits,. yogurt have alot of sugar Refer to HO or click on the following link: All about Carbohydrate Counting The recommended number of servings is based on weight, activity level, diabetes medicines, and goals for blood glucose levels. The dietitian or diabetes educator, will work with the patient to make a personalized plan. A general guideline is to have • 45-60 grams of carbohydrate at each meal • 15-20 grams of carbohydrate servings at each snack

hypoglycemia preventative measure

Take prescribed dose of medication at the proper time. Accurately administer insulin Ingest recommended foods at proper time. Provide adequate food intake needed for calories for exercise. Learn and recognize symptoms and treat them immediately Carry a simple CHO, Educate family and coworkers about symptoms and treatment. Wear Medic Alert bracelet.

hyperglycemia preventative measure

Take prescribes dose of medication at proper time. Accurately administer insulin. Maintain diet. Adhere to sick day rules when ill. Check blood glucose as ordered. Wear diabetes identification.

health promotion

Taking insulin Carbohydrate counting Frequent blood sugar monitoring Eating healthy foods Exercising regularly and maintaining a healthy weight Foot Care

blood glucose monitoring

The American Diabetes Association recommends testing blood sugar levels before meals and snacks, before bed, before exercising or driving, and if a person suspects they may have low blood sugar. Careful monitoring is the only way to make sure that the blood sugar level remains within your target range. Continuous glucose monitoring (CGM) is the newest way to monitor blood sugar levels, and may be especially helpful for preventing hypoglycemia. sensor is very expensive. both type 1 and 2 can have glucose pumps

type 1 diabetes causes

The exact cause of type 1 diabetes is unknown. In most people with type 1 diabetes, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain environmental factors, such as viruses, may trigger the disease

pancreas transplant

With a successful pancreas transplant, a person would no longer need insulin. But pancreas transplants are not always successful — and the procedure poses serious risks.

basal insulins

can be long-acting (insulin glargine or insulin detemir) or intermediate-acting (insulin isophane suspension [NPH]). Or it can be given at a continual basal rate via a continuous subcutaneous insulin infusion pump. Basal insulins are given to mimic physiologic continuous insulin release. Long-acting basal insulins have a duration of about 24 hours and usually lack a significant peak effect, helping to smoothly control hepatic glucose output. Intermediate-acting insulin (NPH) has a variable peak action of 4 to 12 hours and a duration of 18 to 24 hours. Because of its strong peak effect and duration shorter than 24 hours, NPH insulin doesn't mimic physiologic basal insulin as closely as long-acting insulins. The hypoglycemia that can occur with NPH may happen when BG levels aren't typically monitored; thus, hypoglycemia may go unnoticed unless the patient recognizes signs and symptoms and alerts hospital staff. For example, the morning NPH dose peaks a few hours after lunch, which may coincide with the peak of short-acting insulin given at lunch, increasing the hypoglycemia risk. The bedtime NPH dose peaks in the early morning (about 4 a.m.).

type 1 info endogenous insulin nutrition status symptoms nutritional therapy insulin vascular and neurological complications

endogenous insulin: absent nutrition status: thin, normal, obese symptoms: polyiria, polyphagia, polydispia nutritional therapy: essential insulin: required vascular and neurological complications: frequent goal is stable sugar levels and good circulation

type 2 info endogenous insulin nutrition status symptoms nutritional therapy insulin vascular and neurological complications

endogenous insulin: initially increased in response to insulin reistance nutrition status: frequently overweight or obese symptoms: usually none, but fatigue, recurrent infections. may have 3 P's nutritional therapy: essential insulin: needed for some vascular and neurological complications: frequent

healthy people 2020

prevention and early detection of DM Increase level of exercise-physical activity reduces the risk of T2DM Maintain a healthy weight-obesity increases risk of T2DM If overweight, lose weight and get on to a regular exercise program to reduce the risk of DM Use a diet that is low in fat content, total calories, and processed foods and high in whole grains, fruits and vegetables If overweight and over age 45, get a diabetes screening test done.

hypoglycemia mild to moderate symptoms

shaky/ gittery sweaty hungry headache blurred vision sleepy/ tired dizzy/ lightheadedness confused/ disorientated uncoordinated irritable/ nervous argumentative/ combative changed behavior or personality trouble concentrating weak pale tachycardia

type 2 diabetes causes

the islet cells are still functioning, but the body becomes resistant to insulin or the pancreas doesn't produce enough insulin or both. Exact cause is unknown, although genetics and environmental factors, such as excess weight and inactivity, seem to be contributing factors.

macrovasuclar disease

transient ischaemic attack stroke angina myocardial infarction cardiac failure peripheral vascular disease

hypoglycemia severe symptoms

unable to eat or drink seizures or convulsions unconsciousness