1. Interventions for Clients with Diabetes Mellitus

2. 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

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

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

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

8. 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

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

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

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

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

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

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

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

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

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

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

19. 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

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

21. 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

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

23. 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.

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

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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

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