Diabetic Teaching

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Diabetic Teaching

Diabetic teaching

MetforminWhat is it: Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood).How it works: Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood.When it is to be taken: Metformin should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment.Dosage:Metformin with insulin: At first, 500 mg a day. Your doctor may increase your dose by 500 mg every week if needed until your blood sugar is controlled. However, the dose is usually not more than 2500 mg per day. Noncompliance of the medication: individuals with type 2 diabetes have insulin resistance(a condition in which the cells of the body become resistant to the hormone insulin). This causes the cells to ignore the effects of insulin and not allow glucose to be transported into the muscles and tissues where it is vital to produce energy. The body tries to compensate by secreting more insulin, which only leads to hyperinsulinemia in the blood(amount of insulin in your blood is higher than what's considered normal). If a patient stops taking metformin, the type 2 diabetes effects occur due to insulin resistance causing symptoms such as severe thirst, hunger and urinary frequency.Side Effects:Although most people tolerate metformin well, there are some potential side effects of the medication. Some examples of common metformin side effects include diarrhea, nausea, and gas.Humulin Regular InsulinWhat is it:Exogenous Sudcutaneous Injectable Hypoglycemic Agent. How it works:For people with diabetes, either the pancreas does not make enough insulin to meet the body's requirements, or the body cannot properly use the insulin that is made. As a result, glucose cannot be used or stored properly and accumulates in the bloodstream. Insulin injected under the skin helps to lower blood glucose levels. Regular insulin is a fast-acting insulin. It takes 30 to 60 minutes to begin working after injection, and has its maximum effect between 2 and 4 hours after injection. It stops working after 6 to 8 hours.When it's to be taken:20 untits in the morning and 5 units at supperInsulin Injection sites:The most common injection site is the abdomen (or stomach). The back of the upper arms, the upper buttocks or hips, and the outer side of the thighs are also used.These areas are easy to reach and have ample amounts of have fatty tissue (called subcutaneous fat). These areas also reduce the risk of injecting insulin too close to a large blood vessel or nerve.Importance of rotation:Keep accurate records of your site rotation.This will help you avoid injecting the same area repeatedly. Doing so is likely to result in the development fat deposits that can make your skin look lumpy and delay the absorption of insulin.Side Effects: The most important side effect that can occur with Humulin R is low blood sugar. As your body adjusts to the medicine during treatment these side effects may go away. Protocol for missed doses:If you realized you missed a dose and it is within the hour than you can take your normal dose. If it within 2 hours later take 75% of the normal dose. If it is 3 hours later take half of your normal dose.AdministrationPicking out needles and where to store them:Since she is taking less than 30ml its reccommeded using a 3/10ml syringe 6mm barrell with a 32 Gague needle. Use a sturdy, non-see-through plastic container, such as a detergent bottle, to dispose of your sharps. When its ¾ full, tape it shut and throw it away in the regular trash; do not recycle. You could also add bleach and water (one part bleach, nine parts water solution). Do not use coffee cans, because they can split open when trash is compacted.Needle Reuse:The harm you can cause yourself by reusing a needle is much greater than any convenience or cost savings. The tips of needles may become damaged after just one injection. (see picture to the right. Difference between a new one and a reused one) Even though you can't see this damage with the naked eye, it's still there - and it may become worse each time you reuse. There are a lot of good reasons not to reuse syringe or pen needles: The tip of a reused needle can be weakened to the point where it breaks off and gets stuck under your skin. A reused needle doesn't inject as easily or as cleanly as a new one and can cause pain, bleeding, and bruising. Studies have shown that there's a link between needle reuse and the appearance of lumps of fatty tissue that can form at an injection site. Never recap needles to prevent finger sticks or cuts to your skin.Insulin Instructions: Humulin R is a clear and colorless liquid with a water like appearance and consistency. Do not use Humulin R if it appears cloudy, thickened, or slightly colored, orif solid particles are visible. Always label the bottle after it is opened so you know when it is going to expire. It can be stored in the fridge for 28 days.In use (opened):The Humulin R bottle you are currently using can be kept unrefrigerated as long as it is kept as cool as possible [below 86°F(30°C)] away from heat and light.Not inuse (unopened):Humulin R 100 bottles not inuse should be stored in a refrigerator 36° to 46° [2°to8°C] but not in the freezer.How to draw up insulin: Preparing the Dose1.Wash your hands. 2.Inspect the insulin. Humulin R solution should look clear and colorless. Do not use Humulin R if it appears cloudy, thickened, or slightly colored, or if you see particles in the solution. Do not use Humulin R if you notice anything unusual in its appearance.3. If using a new Humulin R bottle, flip off the plastic protective cap, but do not remove the stopper. Wipe the top of the bottle with an alcohol swab.4. Draw an amount of air into the syringe that is equal to the Humulin R dose. Put the needle through rubber top of the Humulin R bottle and inject the air into the bottle.5.Turn the Humulin R bottle and syringe upside down. Hold the bottle and syringe firmly in one hand.6.Making sure the tip of the needle is in the Humulin R solution, withdraw the correct dose of Humulin R into the syringe.7.Before removing the needle from the Humulin R bottle, check the syringe for air bubbles. If bubbles are present, hold the syringe straight up and tap its side until the bubbles float to the top. Push the bubbles out with the plunger and then withdraw the correct dose.Preparing the injection site:1.To avoid tissue damage, choose a site for each injection that is at least 1/2 inch from the previous injection site. The usual sites of injection are abdomen, thighs, and arms.2.Cleanse the skin with alcohol where the injection is to be made.3.With one hand, stabilize the skin by spreading it or pinching up a large area.4.Insert the needle as instructed by your doctor.5.Push the plunger in as far as it will go.6.Pull the needle out and apply gentle pressure over the injection site for several seconds. Do not rub the area.Patient teaching:FOCUS ON THE FAT!!To make shots painless as possible :Inject insulin at room temperature, lat the alcohol you use toclean your skin with dry so that it so it doesnt burn, relax dont tense up, take some deep breaths and calm yoourself, inject and remove the needle in a swift smooth manner.simvastatin: is used to lower the "bad" cholesterol and triglycerides in the blood while increasing levels of good cholesterol. Verify with your doctor about c orrect dosage and frequency of this medication. Avoid grapefruit and grapefruit juice as it may increase unwanted side effects such as headache, abdominal pain, and flu like symptoms. OTC advil: reduces inflammation in your body. It should be taken as needed. Some side effects are bloating, abdominal pain, sour stomach, and swelling in the limbs and face. diovan HCT 80/12.5: is used to lower your blood pressure. It should be taken once a day. Some side effects are difficulty breathing, increased thirst, confusion, irregular heartbeat, and bloody urine. st. johns wort extract 300mg: is used for depression, insomnia, and nervousness. It can be taken up to three times a day. Side effects are weight gain, tiredness, and dry mouth

Managing Diabetes

Foot careDiabetes is the leading cause of non-traumatic amputation of the lower extremeties in the united states. With damage to the nervous system a person with diabetes may not be able to feel their feet. You may also not be able to sense the position of your feet while walking and feel your shoes if they are rubbing against your feet and toes. Always wear well fitted shoes and light colored socks that way if you do have a cut/sore you will be able to see blood and become aware of an injury. Inspect your feet every day after bathing and make sure to wash and dry feet good. Avoid high temp water to prevent burns. Apply a thin layer of lotion to the feet to prevent cracking of the skin and avoid lotion in between the toes to prevent infection. Never go barefoot and always wear shoes that protect your feet to prevent any risk for injury or infection. When to contact your doctor: Athletes foot when you have cracks between the toes, sores that do not heal,ingrown toenails, numbness or pain, blackenng of the skin or any bunions.

Skipping meals may put you at risk for low blood sugar..Try scheduling your meals and stick to routine. Choose fresh fruits and vegetbales. Fish 2 to3 times a week. Choose lean pork or beef . Include diary and whole grain foods. Eat breakfast before you leave for the day and pack yourself a lunch and supper for when you have a drive. Try making a sandwhich with whole wheat toast and low sodium lunch meat. You can also have non-starchy vegetables such as cucumbers, tomatoes and lettuce. You can also have a low sodium soup or a salad on the go with the dressingon the side(limit dressing to 2 tablespoons). Meal replacement shakes are a good choice also such as slimfast low-carb and boost gucose control.Exercise Muscles are the tissues in your body that use the most glucose, and they can help keep blood glucose levels from soaring. Benefits of exercising is it boosts the body's use of insulin, lowers BP, Helps maintain a healthy weight, promotes relaxation by reducing stress, and reduces the risk of diabetes complications such as heart disease, kidney disease and stroke. Take the stairs instead of the elevator. Or get off a few floors early and take the stairs the rest of the way.Walk around your building for a break during the work day or during lunch. Park further away from your work building and walk the extra steps.If you're doing intense exercise, your blood sugar levels may rise, temporarily, after you stop. Sometimes people experience a drop in blood glucose during or after exercise, so it is very important to monitor your blood glucose, take proper precautions, and be prepared to treat low blood sugar.To learn how different types of activity affect you, you should frequently check your blood glucose before, during, and after an exercise session. If your blood glucose levels are trending down before a workout, have a pre-exercise snack. Always carry a carbohydrate food or drink (like juice or glucose tabs) that will quickly raise your blood glucose. If your blood glucose level is less than 100 mg/dl before you start your activity, try having a small carbohydrate snack (about 15 grams) to increase your blood glucose and reduce your risk for hypoglycemia. This is especially important if you anticipate that your body’s circulating insulin levels will be higher during the time you exercise and if you will be exercising for longer than 30 minutes.The recommended weekly goal of about 150 minutes of exercise sounds like a lot, but that breaks down to just 30 minutes on five days during the week. And you can break those half-hours up throughout the day Weight ManagementA National Institutes of Health study found that a combination of diet and exercise cuts the risk of developing diabetes by 58%. If someone with diabetes loses 5% to 10% of their weight, they will significantly reduce their blood sugar, have lower BP, better cholesterol levels, and less stress on the hips, knees, and feet.StressManagement Practice muscle relaxation, deep breathing, meditation, or visualization. Challenge yourself to learn how to relax. the best way to live with stress is to prevent it.Do not put yourself in situations or with people who you know cause stress. Try to catch yourself before you overreact or get angry. Negative thoughts often end up in negative results. Try to find at least one positive thing, even in the most challenging situations. Practice saying "I can", "I will", and "I'll give it a try". Positive thoughts oftenlead to positive results.Plan some time every day just for you. If you are not used to doing this, start with 15 minutes a day. Take time to read that book you have had for six months, treat yourself to a movie or indulge in a leisurely bubble bath. Be adventuresome! Find time to enjoy life's simple pleasures and learn how to be kind to yourself. Do something special and join a support group. Diabetes support groups allow you to meet other people who face some of the same kind of challenges you do living with diabetes. Along with all those stick with a healthy diet and exercise regularly.Record KeepingKeeping track of your diabetes can be challenging but it can help you manage your diabetes. Some things to write down are date and day of the week, time and result of test, time you took insulin or diabetes pill, type and dose of insulin or diabetes pill, things that affected your blood sugar like exercise, eating, being sick or stressed. Even though test results might not always be what you want or expect, all results are helpful. From them you can learn more about how to manage your diabetes. When you understand how high and low results can help you get back on track, you won't get discouraged when results aren't what you expect.Take your test results with you when you visit your doctor. Write down your results even when they're normal. When your blood sugar is in the normal range, think about what you did to help get it there. But don't be surprised or disappointed if you do the same things tomorrow and get different results. Blood sugar levels can go up and down without an obvious reason. Set realistic goals so you won't get frustrated or disappointed.


TreatmentsDO NOT REUSE TEST STIPS AS TO THEY WILL GIVE YOU A FALSE RESULT AND MAY LEAD TO DANGEROUS SIDE EFFECTS. Finger stick blood sugar checks and results: used to track your blood sugar for signs and symptoms of high and low blood sugar. The best times to test are before meals, before bed, One to two hours after meals. How to perform a finger stick blood sugar: . 1. Wash your hands or clean your finger or other site with alcohol. If you are using alcohol, let it dry before you prick your finger 2.Prick the site with a lancing device 3. Put a little drop of blood on a test strip 4. Place a cotton ball on the site and apply pressure until it stops bleeding 5. wait for the results and record them on a notepadContact your doctor if your blood sugar is above 350. If your blood sugar is below 70 eat a snack high in protein such as peanut butter crackers or drink some orange juice. Signs of hypoglycemia: sweating and chills, shakiness, nausea and confusion. Hypoglycemia may also be referred to as an insulin reaction, or insulin shock. Signs of hyperglycemia: Hyperglycemia can be a serious problem if you don't treat it, so it's important to treat as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel, so your body breaks down fats to use for energy. Symptoms include shortness of breath, fruitty breath odor, and increased thirst and urination. Wearing a medical alert bracelet is important in the event in a severe hypoglycemic episode. This will inform anyone that you are diabetic and what kind of care they can give to you and weather or not you use insulin and have any allergiesGetting yearly Influenza and Pneumococcal vaccinations are essential to diabetics to prevent illness. Getting sick can cause fluxuations in blood sugars.

Health and KnowledgeMicrovascular complications and prevention: Nephropathy (end stage renal disease) The first symptom of kidney disease is often fluid buildup. Swelling in the feet, ankles, and legs. Keep your blood sugar levels within your target range. Manage your blood sugar by eating healthy foods, taking your medicine, and getting regular exercise.Keep your blood pressure under control with medicine, diet, and exercise. Neuropathy: Three types of nerve can be involved; autonomic nerves, motor nerves and sensory nerves.Sensory nerves (the nerves that control sensation) causing cause tingling, pain, numbness, or weakness in the feet and hands Motor nerves (the nerves that allow power and movement) causing weakness in the feet and hands. Autonomic nerves (the nerves that control the systems of the body eg gut, bladder) causing changes in the heart rate and blood pressure or sweating. It is nerve pain that cause amputations, nerve pain from poor circulation, and Peripheral Vascular Disease.Exercise regularly. With your doctor's okay, try to get at least 30 minutes to one hour of exercise at least three times a week. Avoid factors that may cause nerve damage, including repetitive motions, cramped positions, exposure to toxic chemicals, smoking and overindulging in alcohol.Retinopathy: diabetes complicatin that affects the eyes.t's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness.You can't always prevent diabetic retinopathy. However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.Macrovascular complications and prevention: Coronary artery disease: Coronary artery disease develops when your coronary arteries — the major blood vessels that supply your heart with blood, oxygen and nutrients — become damaged or diseased. Cholesterol-containing deposits (plaque) in your arteries and inflammation are usually to blame for coronary artery disease. CAR can lead to chest pain(angina), heart failure and irregualr heartbeat.To improve your heart health, you can: Quit smoking, Control conditions such as high blood pressure, high cholesterol and diabetes Stay physically active. Eat a low-fat, low-salt diet that's rich in fruits, vegetables and whole grains. Maintain a healthy weight Reduce and manage stress.Cerebral vascuar accident: A cerebral vascular accident is another name for a stroke. An operation to clean out the carotid artery and restore normal blood flow through the artery markedly reduces the incidence of a subsequent stroke. Glycosylated hemoglobin test HbA1c: is to be done every three months. It tests your blood sugar levels and will give you an average of what your blood sugars have been within the last three months.fasting blood sugar: usually done first thing in the morning. Do not eat or drink anything 9 to 12 hours before the test as it will not give the lab the most accurate result of yur blood sugar.Lipids: Usually done every five years. A lipid panel is a blood test that measures lipids-fats and fatty substances used as a source of energy by your body. Lipids include cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Hyperglycemic Hyperosmoloar nonketotic syndrome: is a serious condition where your blood sugar spikes above 600mg/dl causing you to become very dehydrated. It is usually found in older adults. your body tries to get rid of the excess sugar by passing it into your urine. You make lots of urine at first, and you have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may be very thirsty. Even if you are not thirsty, you need to drink liquids. You may get sent to the hospital. You’ll get an IV to replace lost fluids and electrolytes such as potassium and you’ll get insulin or other medication to control your blood sugar. Take these simple steps to help protect yourself: Check your blood sugar regularly, as your doctor recommends. Know your target blood sugar ranges and what to do if the readings are too high. Plan how often to check your blood sugar when you’re sick.Take extra care of yourself if you’re ill. If you have diabetes and you smoke, you are more likely to have serious health problems from diabetes. Smokers with diabetes have higher risks for serious complications, including: Heart and kidney disease Poor blood flow in the legs and feet that can lead to infections, ulcers, and possible amputation (removal of a body part by surgery, such as toes or feet) Retinopathy (an eye disease that can cause blindness) Peripheral neuropathy (damaged nerves to the arms and legs that causes numbness, pain, weakness, and poor coordination) If you are a smoker with diabetes, quitting smoking will benefit your health right away. People with diabetes who quit have better control of their blood sugar levels.

Diabetes MellitusWhat is it? With type 2 diabetes, your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. S/S of diabetes:Increased thirstFrequent urinationExtreme hungerUnexplained weight lossPresence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin)FatigueIrritabilityBlurred visionSlow-healing sores. Risk factors:Weight. The more fatty tissue you have, the more resistant your cells become to insulin.Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.Family history. Your risk increases if a parent or sibling has type 2 diabetes.Race. Although it's unclear why, people of certain races — including blacks, Hispanics, American Indians and Asian-Americans — are at higher risk.Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. Ideal BS range: 70-120mg/dl

Interdisciplinary teamworkDiabetic Educator: A key member of the diabetes management team, a diabetes educator will help you learn how to take care of yourself -- guide you through your treatment and help you with any fears, issues and problems you encounter along the way. Dietician: A dietician promotes healthy diets through education and education programs. The dietician can help you put together a diet based on your health goals, tastes and lifestyle and can provide valuable information on how to change your eating habits. Doctors: you will usually visit the doctor every 6 months for general checkups and have labs every 3 months to check your blood levels.An Opthalmologist is another key member of your diabetes care team, because diabetes can affect the blood vessels in the eyes.A Podiatrist is trained to treat feet and problems of the lower legs. For anyone with diabetes, which can cause nerve damage in the extremities, foot care is important. A dentist is another person on your healthcare team. People with diabetes are at somewhat greater -- and earlier -- risk of gum disease. The excess blood sugar in your mouth makes it a nice home for bacteria, which can lead to infection. You should see your dentist every six months. Refferals, agencies, or assistance: almost all hospitals offer diabetic teaching to people. There are also great brochures you can get from the hospital or a dietician.You can visit the American Diabetes Association for more information. Also look for community support groups or organizations in your area.

Meal managementavoiding fas food when you are a diabetic is unrealistic but instead make healthier choices. Stay away from double burgers or "super" hot dogs with cheese, chili, or sauces.Order a regular or junior-sized sandwich instead. Order items plain, without toppings, rich sauces, or mayonnaise. Add flavor with mustard, and crunch with lettuce, tomato, and onion.Ask for your sandwich or burger without the cheese. Choose grilled or broiled sandwiches with meats such as lean roast beef, turkey or chicken breast, or lean ham. Go for the salad bar and fill your salad with things like carrots, peppers, onion, celery, broccoli, cauliflower, spinach, and other veggies. Toss on a few sunflower seeds to add some healthy fats and add lean protein like grilled chicken or beans or chick peas to add some protein.Watch out for potato and macaroni salads that are dressed with a lot of mayo, and other high-calorie toppings like dressings, bacon bits, cheeses, and croutons. Watch out for deep-fried taco salad shells - a taco salad can have more than 1,000 calories!Pizza can be a good fast food choice. Go for thin crust pizza with vegetable toppings. Limit to 1-2 slices. Meat and extra cheese add calories, fat and sodium.Chinese food may seem like a healthy choice, but many dishes are deep fried or high in fat and sodium, especially in the sauces. You can ask for the sauce on the side so you eat less. Skinless fried chicken can have almost as much fat as the regular kind. Try making meals ahead of time and freezing them. Take time out of one day to plan and cook for an entire week that way you don't eat out as much. A registered dietician would be able to help you figure out how any carbs you can have a meal and help you calorie count. The American Diabetes Association has a great website that you can log on to and see updated information about the standards of care for diabetics. If you choose to drink alcohol, drink in moderation. Limit your intake of alcohol to no more than one serving per day. One serving size of alcohol equals: 12 ounces of beer 5 ounces of wine 1½ ounces of distilled spirits Try packing some portable healthy snacks like raw vegetables and fresh fruits, mixed nuts that are lightly salted, protein shakes, whole wheat crackers with peanut butter. More than 2.8 million African-Americans have diabetes and has contributed to 25,000 deaths. African-Americans suffer from many preventable complications: 9,000 lower extremity amputations, 4,000 new cases of end stage renal disease, and 3,000 new cases of blindness.

High Blood PressureSustained BP above 140/90. It is important to monitor your BP and take measures to lower it by taking medications and exercising. If it is left untreated you could have a stroke or have cardiovascular diseases.


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