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 DMFoundation 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 = 60-90 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

system3. 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?