I. HEALTH PROMOTION
A. Diet management
Goal – maintain as near normal blood glucose levels as possible by balancing food intake with insulin or oral glucose.
Balanced meals – consistent carbohydrate diabetes meal. Eat a similar amount of carbohydrates at each meal. Insulin administered based on carbohydrate intake. 1 Unit of regular insulin for each 10-15 g carbohydrate eaten at a meal. This method is thought to provide a better connection between food,
Medications and exercise.
Regular intervals – snacks are important
Limit salt and sugars –sodium associated with hypertension, a common health problem for diabetes Recommend 1-3gm per day. Restrict amount of refined sugars
Avoid alcohol—may potentiate the hypoglycemic effects of insulin and oral agents.
Weight control
B. Exercise
Regular exercise program - increases the uptake of glucose by muscle, potentially reducing the need for insulin
Also decreases cholesterol and triglycerides, reducing the risk of cardiovascular disorders.
For type 2 diabetics produces an increased sensitivity to insulin and an increased kcal expenditure. Weight loss in overweight individuals also a benefit.
Low-impact aerobics are encouraged. Start slow and gradually increase intensity and duration.
Self-monitor blood glucose before and after exercise. Have a carbohydrate source available after exercise. Blood levels will fall after the first 60-90 minutes of exercise.
C. Medications
Insulin - Complete the chart in handout packet
Oral hypoglycemics – may be used in combination with insulin to produce better control of blood sugars.
II. HEALTH MAINENANCE/ILLNESS PREVENTION
A. Skin integrity – decreased or absent sensation from neuropathies. Delayed healing, increased risk for infections,
B. Foot care – diabetics are at significant risk for lower-extremity ulcers. Foot care teaching should repeated as often as necessary. SEE page 499 Lemone for foot care teaching session information.
C. Prevent infections – Risk of infection is thought to be due to vascular insufficiency that limits the inflammatory response, neurologic abnormalities that limit the awareness of trauma and a predisposition to bacterial and fungal infections. HANDWASHING – single most effective method for preventing spread of infection.
D. Yeast – diabetes is a predisposing factor for candida albicans vaginitis.
E. Dental health – careful hygiene , regular dental exams
F. Sexual dysfunction – alterations in erectile ability occurs in approximately 50% of all men with diabetes. Impotence increases with duration of diabetes. Women report decreased desire and decreased vaginal lubrication.
G. Coping strategies – Chronic disease with lifelong implications. Necessary lifestyle changes. Fear of potential complications.
III. ILLNESS CARE/ COMPLICATIONS
A. Type 1 Diabetes - defination
Diabtic Ketoacidosis ( DKA)
Dehydration from hyperglycemia
Warm dryskin, poor turgor
, weak pulse
Hypotension
Malaise
Nausea and vomiting
Fruity alcohol-like breath odor
Kusmauls respirations
B. Type 2 Diabetes - defination
Normal is 280-300
Blood glucose over 600
Altered levels of consciousness
Percipitating Factors
Infection is most common
Manifestations
Slow onset 24 hr –2 weeks
Patients are usually Older clients
B. Illness effect on blood sugar level
C. Effect on surgical patient
D. Long term systemic complications of diabetes