DIABETES MELLITUS
Management With Health Promotion:
• Obesity is #1 predictor of type II
• Leading cause for:
o Adult blindness
o Renal disease
o Amputation
• First relative à higher risk
• Higher prevalence in native Americans, Alaskan Americans, Asians, Hispanics
• Routine screening for all adults who are overweight and have additional risk factors
o should begin at age 45 in people without risk factors à every 3 years
Diagnosing:
• be supportive & non-judgmental
• assess knowledge level of disease
• dx can affect the pt in so many ways
• it is demanding to self-manage
• diagnostic labs:
o HgA1C à > 6.5%
o Oral glucose tolerance test à mostly for preg. à >200
o Fasting BG à >126
o Random BG à >200 w 2-3 symptoms of hyperglycemia
Goals of Diabetes Management:
• engage in self-care behaviors to actively manage diabetes
• have few or no hyperglycemia or hypoglycemia emergencies
• maintain blood glucose levels at normal or near-normal levels à want 80-130 before meals
• reduce the risk for chronic complications from diabetes
• adjust lifestyle to accommodate the diabetes plan with minimum stress
o drug therapy:
§ insulinà long, short, and rapid acting à all individuals with type I need insulin
§ oral agents, diet, exercise, weight loss à type 2
, Client Teaching:
• perform an initial nutritional assessment and plan to individualize meal plan
o carbohydrate (45-60g/ meal)
§ include carbs from fruits, vegetables, grains, legumes, and low-fat milk
§ fiber intake at 14g/1000 kcal/day
§ nonnutritive sweeteners are safe when consumed within FDA daily intake levels à stevia
o protein and fats
§ individualize goals
§ consume fat from plant products à olives, avocados
§ > 2 servings of fish per week
Carbohydrate Counting:
• Meal planning technique used to keep track of carbs eaten with each meal per day
• The amt of carbs/day depends on BG levels, age, weight, activity level, pt preference, and prescribed meds
• A serving size is 15g
• Typically adults start with 45-60g/meal
o For some pts insulin is tailored to amt of carbs/meal
• Ex. slice of bread, apple, cup of soup, half cup ice cream
o Breakfast à 2, 4 in pancakes, light maple syrup, unsweetened juice
o Lunch à turkey, 2 slices of bread, ½ banana, skim milk
o Dinner à chicken breast, potato, leuce, ranch
Alcohol & Diabetes:
• Limit to moderate amt if no risk for other alcohol-related problems
o 1 drink/day for women
o 2 drinks/day for men
o Beer = 12oz, wine = 4oz, 80 proof = 1.25oz
• Inhibits gluconeogenesis by the liver à drinking w/o eating
o Causes severe hypoglycemia
o Eat carbs when drinking unless drinks have sweetened mixers
• Create trust so patients honestly report intake; glucose harder to manage
Patient Teaching Regarding Exercise:
• Teach your pt why exercise is important
o Decreases insulin resistance and BG à adipose tissues = inflammation à makes insulin receptor less effective
o Weight loss
o Reduce need for meds (type II)
o Decreases triglycerides and LDL à increased HDL
o Decreases BP and increases circulation
• How much exercise should be encouraged?
o Regular, consistent exercise plan is essential
o At least 150 minutes/week of moderate-intensity aerobic activity
o Resistance training 2-3x a week
Management With Health Promotion:
• Obesity is #1 predictor of type II
• Leading cause for:
o Adult blindness
o Renal disease
o Amputation
• First relative à higher risk
• Higher prevalence in native Americans, Alaskan Americans, Asians, Hispanics
• Routine screening for all adults who are overweight and have additional risk factors
o should begin at age 45 in people without risk factors à every 3 years
Diagnosing:
• be supportive & non-judgmental
• assess knowledge level of disease
• dx can affect the pt in so many ways
• it is demanding to self-manage
• diagnostic labs:
o HgA1C à > 6.5%
o Oral glucose tolerance test à mostly for preg. à >200
o Fasting BG à >126
o Random BG à >200 w 2-3 symptoms of hyperglycemia
Goals of Diabetes Management:
• engage in self-care behaviors to actively manage diabetes
• have few or no hyperglycemia or hypoglycemia emergencies
• maintain blood glucose levels at normal or near-normal levels à want 80-130 before meals
• reduce the risk for chronic complications from diabetes
• adjust lifestyle to accommodate the diabetes plan with minimum stress
o drug therapy:
§ insulinà long, short, and rapid acting à all individuals with type I need insulin
§ oral agents, diet, exercise, weight loss à type 2
, Client Teaching:
• perform an initial nutritional assessment and plan to individualize meal plan
o carbohydrate (45-60g/ meal)
§ include carbs from fruits, vegetables, grains, legumes, and low-fat milk
§ fiber intake at 14g/1000 kcal/day
§ nonnutritive sweeteners are safe when consumed within FDA daily intake levels à stevia
o protein and fats
§ individualize goals
§ consume fat from plant products à olives, avocados
§ > 2 servings of fish per week
Carbohydrate Counting:
• Meal planning technique used to keep track of carbs eaten with each meal per day
• The amt of carbs/day depends on BG levels, age, weight, activity level, pt preference, and prescribed meds
• A serving size is 15g
• Typically adults start with 45-60g/meal
o For some pts insulin is tailored to amt of carbs/meal
• Ex. slice of bread, apple, cup of soup, half cup ice cream
o Breakfast à 2, 4 in pancakes, light maple syrup, unsweetened juice
o Lunch à turkey, 2 slices of bread, ½ banana, skim milk
o Dinner à chicken breast, potato, leuce, ranch
Alcohol & Diabetes:
• Limit to moderate amt if no risk for other alcohol-related problems
o 1 drink/day for women
o 2 drinks/day for men
o Beer = 12oz, wine = 4oz, 80 proof = 1.25oz
• Inhibits gluconeogenesis by the liver à drinking w/o eating
o Causes severe hypoglycemia
o Eat carbs when drinking unless drinks have sweetened mixers
• Create trust so patients honestly report intake; glucose harder to manage
Patient Teaching Regarding Exercise:
• Teach your pt why exercise is important
o Decreases insulin resistance and BG à adipose tissues = inflammation à makes insulin receptor less effective
o Weight loss
o Reduce need for meds (type II)
o Decreases triglycerides and LDL à increased HDL
o Decreases BP and increases circulation
• How much exercise should be encouraged?
o Regular, consistent exercise plan is essential
o At least 150 minutes/week of moderate-intensity aerobic activity
o Resistance training 2-3x a week
