Endocrine Lecture Day 2 a

S&S of Hyperglycemia Neuro – Fatigue – C/O headache – Dull senses – Stupor – Drowsy – Loss of Consciousness – Blurred Vision

S&S of Hyperglycemia Cardiovascular – Tachycardia – Decreased BP – (Dehydration) Respirations – Kussmaul's respirations – Sweet and fruity breath – Acetone breath

S&S of Hyperglycemia Gastro-intestinal – Polyphagia – (Decreased hunger in late stages) – N/V – Abd. Pain – Polydipsia – Dehydration

S&S of Hyperglycemia Genital-urinary – Polyuria – Nocturia – Glycosuria Skeletal-muscular – Weak – Uncoordinated

S&S of Hyperglycemia Integumentary – Dry skin – Flushed face – Hypothermia

Small Group Questions Mr. McMillan is a 50 year old client brought into the ER with extreme fatigue and dehydration. After the MD sees him the nurses asks Mr. McMillan some additional questions. Based on the clients answers the nurse requests that the MD add a glucose level to the lab work. The results are 800mg/dL.

Small group questions What question did the nurse most likely ask? Why was Mr. McMillan fatigued? Why was he dehydrated?

Medical Management of DM No cure Goal is Control! And prevent complications Individualized treatment plans – Diet – Exercise – Meds

Surgical management of DM Can we do a pancreas transplant? – YES! Not usually done Islet cell transplants

Dietary management of DM Foundation of Diabetic control Goals – Maintain near-normal blood glucose levels – Achieve optimal serum lipid levels – Provide adequate calories for reasonable weight – Prevent & treat acute complications of insulin- treated diabetes – Improve overall health through optimal nutrition

R.D. Registered dietitian

The exchange system Six categories – Bread/starch – Meat – Milk – Vegetable – Fruit – Fat

General guidelines of Dietary Management Protein – 20% Fat – 20% Carbohydrates – 60% ADA: American Diabetic Association

NCLEX test question In teaching the newly diagnosed diabetic about the exchange system, the nurse explains that potatoes would be considered A.a vegetable exchange. B.a meat exchange. C.a starch-bread exchange. D.a fruit exchange.

Diabetic Meal Plan Small frequent meals – CONSISTENCY! Amount of calories Amount of carbohydrates Time Snacks

Diabetic Meal Plan If the pt is obese, the key to treatment is … – Weight los!

Sweeteners Nutritive sweeteners – Not calorie free – Cause less  in BS (than regular sugar) – Sorbitol  laxative effect Non-nutritive sweeteners – Minimal or no calories – Do not  BS

Meal Plan considerations Food preferences Lifestyle Schedule Ethnic / Cultural background

Alcohol and Diabetes Increase risk of … – Hypoglycemia – Affects the liver – Don ’ t take on empty stomach – Esp. if on insulin or oral hypoglycemic meds – Moderation

NCLEX Question A client is noncompliant about adhering to dietary restrictions designed to manage his diabetes. Which statement by the nurse would be most likely to motivate the client to comply with treatment? A.“I don’t understand why you don’t follow your diet.” B.“I understand that following this diet is hard for you. Care you share with me why this has been difficult.” C.“Not following your diet may shorten you life.” D.“Let me review your diet with you again, because you don’t seem to understand it.”

Exercise and Diabetes  blood glucose levels –  the uptake of glucose by body muscle – Potentates the action of insulin  insulin requirement – Effect lasts 24 hours

More Benefits of exercise Increases circulation Improve serum lipid levels Improves cardiovascular status Assist with wt control Decreases stress

Rules for the exercising diabetic Talk to MD first Regular vs. sporadic Correlate exercise and glucose levels Don ’ t exercise when hypoglycemic Don ’ t exercise when hyperglycemic >250

Rules for the exercising diabetic Do not exercise when insulin is peaking Carry a quick source of sugar Best time = minutes after a meal

Rules for the exercising diabetic Proper footwear May need a pre- exercise snack Consistency!

Monitoring Glucose Self-monitoring SMBG Glucometers Urine testing for glucose Have to have skills! 2-4 times a day Continuous glucose monitory system

Monitoring Ketone levels Dipstick method Perform when: – Glucosuria – Unexplained elevated glucose level – Illness – Pregnancy

Small Group Questions 1.Why are pancreas transplants uncommon? 2.Give signs & symptoms of hyperglycemia by body system 3.A diabetic meal plans main goal is to maintain near normal glucose levels. How is this done? 4.The exchange diabetic meal plan is divided into six categories, what are they?

Small Group Questions 5.What affect does alcohol have on a diabetic? 6.What affect does exercise have on a diabetic? 7.What council would you give a diabetic regarding exercise?