1. Management
2. diet therapy and weight loss
1. the total number of calories is individualized according to the client's weight
2. as prescribed by the care provider, the client may be advised to follow dietary guidelines for Americans (food guide pyramid) or individualized food exchanges from the American Diabetic Association
3. exercise
1. lowers glucose level and improves circulation
2. decreases total cholesterol and triglycerides
3. instruct client to monitor glucose before exercising
4. before exercise, clients who require insulin should eat a carbohydrate snack with protein to prevent hypoglycemia
4. insulin
1. used in type 1 diabetes mellitus (DM) and type 2 DM, if needed for better control of blood glucose levels
2. regular insulin, the only insulin that is given IV, is used for ketoacidosis
3. check other medications the client is taking
4. illness, infections, and stress increase the need for insulin
5. instruct client about the importance of rotating injection within one region (the abdomen absorbs insulin the most rapidly)
6. insulin administration: see Pharmacology section of this course
7. insulin pens, jet injectors, and insulin pumps are used to administer insulin
5. oral antidiabetic medications
1. prescribed for clients with type 2 DM
2. monitor blood glucose levels
3. check other medications the client is taking
4. instruct the client to recognize manifestations for hypoglycemia and hyperglycemia
5. pancreas transplant
6. islet cell transplant
7. blood glucose monitoring - with different self-check systems
6. Medications
7. type 1 DM: insulin therapy
8. type 2 DM: oral hypoglycemic agents
   
9. Complications
10. hypoglycemia(insulin shock)
1. blood sugar falls below 50 mg / dl
2. caused by too much insulin, too little food, or excessive physical activity
3. may result from delayed meals, exercise, or vomiting
4. rapid onset
5. findings of insulin shock
• diaphoresis; cold, clammy skin
• anxiety, tremor, slurred speech
• weakness
• nausea
• mental confusion, personality changes, altered LOC
• headache
6. management of hypoglycemia
• if client is conscious, give oral sugar: hard candy, honey, Karo syrup, jelly, cola
• if unconscious: give one mg glucagon IM, IV or subcutaneous (SC); or 20 to 50 ml 50% dextrose IV push
  
11. diabetic ketoacidosis (DKA) - an acute complication
1. results from severe insulin deficiency
2. findings
• blood sugar levels > 350 mg/dl
• elevated ketone levels: sweet odor to breath may also have odor of someone drinking alcohol
• metabolic acidosis: Kussmaul's respirations, flushed appearance, dry skin
• thirst
• polyuria
• drowsiness
• anorexia, vomiting
• may lead to shock and coma
• usual causes:
• undiagnosed diabetes mellitus
• inadequacy of prescribed therapy for diabetes mellitus
• physical stress such as surgery, illness, or trauma in person with diabetes mellitus
• caused by increased gluconeogenesisfrom amino acids and glycogenolysis in the liver
• management:
• correct fluid depletion - IV fluids
• correct electrolyte depletion - replacement particularly of potassium
• correct metabolic acidosis - insulin IV
  
12. hyperglycemic, hyperosmolar nonketotic coma (HHNKC)
1. potentially fatal
2. findings
• severe hyperglycemia; usually > 600 mg/dl
• plasma hyperosmolarity
• dehydration
• altered LOC - decreased
• absence of ketoacidosis
3. usually precipitated by physical stress such as an infection;
4. in non-diabetics can be due to tube feedings without supplemental water, or too rapid rate of infusion for parenteral nutrition
5. occurs more often in the elderly, typically
6. expected: to correct fluid depletion, insulin deficiency, and electrolyte imbalance
13. other chronic complications
1. diabetic triopathy
• retinopathy
• nephropathy
• neuropathy
2. macrovascular disease in the
• coronary artery
• peripheral vascular
  
14. Nursing interventions
15. give medications as ordered
16. monitor for findings of hyperglycemia or hypoglycemia
17. help client monitor blood glucose
18. refer client to dietician for planing of meals
19. support client emotionally
20. teach client
1. the importance of balanced, consistent daily focus of diet, medication and exercise
2. self blood-glucose monitoring
3. dietary exchange system or refer to appropriate resources
4. about medications and side effects
5. foot care 
6. early reporting of complications of
• ketoacidosis
• insulin shock
• long term issues
7. about insulin administration
8. about the need to:
• eat more before strenuous exercise
• carry extra rapid-absorbing carbohydrate on person at all times
• wear medical-alert jewelry
• have regular eye exams
• consider emergency care for insulin shock
  

About Insulin

• In the pancreas's islets of Langerhans, beta cells secrete insulin-the islet-cell hormone of major physiological importance;
• Without sufficient insulin, the body develops diabetes mellitus.
• Exploration of a number of new delivery systems for insulin is ongoing.
• Implanted insulin delivery systems, in combination with a glucose sensor may create an "artificial pancreas."
• Exercise increases the body's metabolic rate to result in a decrease in blood sugar and an increase in insulin sensitivity. Signs of hypoglycemia often occur.
• Illness can disrupt metabolic control and raise blood sugar, which results in an increased need for insulin.
• Insulin-dependent clients should be well controlled for at least one week prior to any surgery.
• Special care for any client with either type of diabetes mellitus should be taken to monitor blood glucose during and after surgery and adjust insulin accordingly. About the Thyroid
• Following neck surgery, potentially life-threatening complications such as laryngeal edema and tracheal obstruction can occur. Monitor for respiratory distress.
• Following thyroid surgery, many clients suffer transient hypocalcemia from hyporfunction or removal of the parathyroids. Monitor for signs of tetany for up to three days after surgery.

About the Parathyroid

• Positive Chvostek's sign: contraction of facial muscle near mouth occurs when light tap is given over facial nerve in front of ear.
• Positive Trousseau's sign: carpopedal spasm results during the deflation of a blood pressure cuff that has been inflated for at least one minute.
  

Calcitonin
Corpus luteum
Hashimoto's thyroiditis
Hyperplasia
Medullary carcinoma
Microangiopathy
NPH insulin
Papillary adenoma
Polyphagia