Diabetes II
Pathophysiology Course
Treatment - Nursing Intervention
Chronic Complications
D–DIET –Low carbs
AVOID: Simple Sugars (soda, candy, white bread/rice, juices)
• Good High Fiber = BROWN (bean, rice, bread, peanut
butter)
“whole wheat/grain/milk”
• Bad Low fiber = White (bread, rice, bread potatoes (fries),
low fat milk)
KIDNEY–Nephropathy (High Creatinine OVER 1.3)
EYE–Retinopathy (blind)
HEART–HTN & Atherosclerosis
BRAIN–CVA (strokes)
NERVES–Neuropathy (loss of feeling)
D–DIABETIC FEET “Delicious Feast for bacteria”
GOAL: Clean, Dry, Injury Free
AVOID
F–Flip Flops, high heels, Nylon,
O–OTC corn removal
O–Overly HOT (baths, pads etc.)
T–Toe Injuries — cut nails STRAIGHT
NCLEX KEY WORDS:
Daily inspection — NOT weekly
Shoes fit properly — NO sandals
SOFT Cotton Socks — NOT nylon
Nails trimmed–cut straight — NOT curved angles
Non healing skin wounds — Report to HCP (Dr.)
NO callous removal
NO heavy powder — light powder
NO rubbing feet hard “vigorously”
NO HOT baths or HOT pads — warm is ok
Oral Hypoglycemics (Type 2 Only)
1. DIET & EXERCISE BEFORE oral meds and insulin
2. METFORMIN–Minimal chance of Low Sugar “hypoglycemia”
1. Weight Loss
2. Lactic Acidosis: NO Alcohol + STOP 48 hours before and
after cath
IV Contrast = Kills Kidney
3. GLIPIZIDE GLYBURIDE–Heart can DIE (bad for CHF)
LOW blood sugar (Avoid alcohol “ETOH” = hypoglycemia)
TOXIC: Renal, Liver & elderly population
Sun Burns = sunscreen & protective clothing
4. THIAZOLIDINEDONE (TZD) Pioglitazone (ONE heart)
NO Heart Failure patients–new pitting edema, crackles (lungs)
NO Liver failure patients “Cirrhosis” “Liver Failure”
Insulin Types
LONG ACTING
NO Peak
NO Mlx
• Detemir
• Glargine
• Levemir =
Long acting
NPH
REGULAR
iNtermediate
NEVER IV drip
or IV bag
Mix clear to
cloudy
Given 2x per
day
Ready to go IV
Regular goes
right into the vein
RAPID
7 Insulin Tips
Aspart/Lispro/
Glulisine
1. Peaks + Plates = Food during PEAK times (prevent HYPOgly=brain die)
2. NO Peak NO Mix = Long acting “old guys”–Detemir & Glargine
3. IVP or IVPB ONLY = Regular insulin “ready to go IV”
4. Draw Up: Clear to Cloudy “you want CLEAR days before cloudy ones”
5. Rotate locations-Macarena-BEST on abdomen
(2 inches from: Umbilicus, Naval, “belly button”)
6. DKA - Type 1–“sick days”–YES INSULIN without food!!!
7. Hypoglycemia (70 or LESS)
Awake = Ask them to Eat (soda, juice, low fat milk)
Sleeping = Stab with IV D50W (dextrose 50)
"Unresponsive" "Responsive ONLY to pain"
ONLY IV insulin
PEAK
30-90 hour
15 minute
ONSET
PEAK
2-4 hour
MOST DEADLY
PEAK
4-12 hour
NO PEAK
Aspart, lispro, glulisine
PEAKS =
Insulin levels
Regular
BEST CHOICE
NPH
Detemir
Glargine
0
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