Interventions for Clients with Diabetes Mellitus

Types of Diabetes Type I Type 2 Gestational Other types include: Genetic defect beta cell or insulin Disease of exocrine pancreas Drug or chemical induced Infections Others

Absence of Insulin Hyperglycemia Polyuria Polydipsia Polyphagia Hemoconcentration, hypervolemia, hyperviscosity, hypoperfusion, and hypoxia Acidosis, Kussmaul respiration Hypokalemia, hyperkalemia, or normal serum potassium levels

Acute Complications of Diabetes Diabetic ketoacidosis Hyperglycemic-hyperosmolar-nonketotic syndrome Hypoglycemia from too much insulin or too little glucose

Chronic Complications of Diabetes Cardiovascular disease Cerebrovascular disease Retinopathy (vision) problems Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction

Assessment History Blood tests Fasting blood glucose test: two tests > 126 mg/dL Oral glucose tolerance test: blood glucose > 200 mg/dL at 120 minutes Glycosylated hemoglobin assays Glucosylated serum proteins and albumin

Urine Tests Urine testing for ketones Urine testing for renal function Urine testing for glucose

Risk for Injury Related to Hyperglycemia Interventions include: Dietary interventions, blood glucose monitoring, medications Oral therapy Sulfonylurea agents Meglitinide analogues Biguanides (Continued)

Risk for Injury Related to Hyperglycemia (Continued) Alpha-glucosidase inhibitors Thiazolinedione antidiabetic agents

Drug Therapy Drug administration Drug selection Insulin therapy: Insulin analogue Short-acting insulin Concentrated insulin Intermediate (Continued)

Drug Therapy (Continued) Fixed-combination Long-acting Buffered insulins

Insulin Regimens Single daily injection protocol Two-dose protocol Three-dose protocol Four-dose protocol Combination therapy Intensified therapy regimens

Pharmacokinetics of Insulin Injection site Absorption rate Injection depth Time of injection Mixing insulins

Complications of Insulin Therapy Hypoglycemia Lipoatrophy Dawn phenomenon Somagyi's phenomenon

Alternative Methods of Insulin Administration Continuous subcutaneous infusion of insulin Implanted insulin pumps Injection devices New technology includes: Inhaled insulin Transdermal patch (being tested)

Client Education Storage and dose preparation Syringes Blood glucose monitoring Interpretation of results Frequency of testing Blood glucose therapy goals

Diet Therapy Goals of diet therapy Principles of nutrition in diabetes Protein, fats and carbohydrates, fiber, sweeteners, fat replacers Alcohol Food labeling Exchange system, carbohydrate counting Special considerations for type 1 and type 2 diabetes

Exercise Therapy Benefits of exercise Risks related to exercise Screening before starting exercise program Guidelines for exercise Exercise promotion

Whole-Pancreas Transplantation Operative procedure Rejection management Long-term effects Complications Islet cell transplantation hindered by limited supply of beta cells and problems caused by antirejection drugs S&P

Risk for Delayed Surgical Recovery Interventions include: Preoperative care Intraoperative care Postoperative care and monitoring includes care of: Cardiovascular Renal Nutritional

Risk for Injury Related to Sensory Alterations Interventions and foot care practices: Cleanse and inspect the feet daily. Wear properly fitting shoes. Avoid walking barefoot. Trim toenails properly. Report nonhealing breaks in the skin.

Wound Care Wound environment Debridement Elimination of pressure on infected area Growth factors applied to wounds S&P

Chronic Pain Interventions include: Maintenance of normal blood glucose levels Anticonvulsants Antidepressants Capsaicin cream

Risk for Injury Related to Disturbed Sensory Perception: Visual Interventions include: Blood glucose control Environmental management Incandescent lamp Coding objects Syringes with magnifiers Use of adaptive devices

Ineffective Tissue Perfusion: Renal Interventions include: Control of blood glucose levels Yearly evaluation of kidney function Control of blood pressure levels Prompt treatment of UTIs Avoidance of nephrotoxic drugs Diet therapy Fluid and electrolyte management

Potential for Hypoglycemia Blood glucose level < 70 mg/dL Diet therapy: carbohydrate replacement Drug therapy: glucagon, 50% dextrose, diazoxide, octreotide Prevention strategies for: Insulin excess Deficient food intake Exercise Alcohol S&P

Potential for Diabetic Ketoacidosis Interventions include: Monitoring for manifestations Assessment of airway, level of consciousness, hydration status, blood glucose level Management of fluid and electrolytes (Continued) S&P

Potential for Diabetic Ketoacidosis (Continued) Drug therapy goal: to lower serum glucose by 75 to 150 mg/dL/hr Management of acidosis Client education and prevention

Potential for Hyperglycemic-Hyperosmolar Nonketotic Syndrome and Coma Interventions include: Monitoring Fluid therapy: to rehydrate the client and restore normal blood glucose levels within 36 to 72 hr Continuing therapy with IV regular insulin at 10 units/hr often needed to reduce blood glucose levels S&P

Health Teaching Assessing learning needs Assessing physical, cognitive, and emotional limitations Explaining survival skills Counseling Psychosocial preparation Home care management Health care resources