What are all the functions of insulin?
- Transports and metabolizes glucose for energy
- Stimulates storage of glucose in the liver and muscle as glycogen
- Signals the liver to stop the release of glucose
- Enhances storage of dietary fat in adipose tissue
- Accelerates transport of amino acids into cells
- Inhibits the breakdown of stored glucose, protein, and fat
What is the main goal of diabetes management?
Normalize insulin activity and blood glucose levels to reduce the development of complications
The ADA recommends HgbA1c less than 6.5%.
What are the three Ps of clinical manifestations of diabetes?
- Polyuria: increased urination
- Polydipsia: increased thirst
- Polyphagia: increased eating
True or false: A glucose tolerance test is more effective than urine testing for diagnosing diabetes in older adults.
TRUE
Urine testing has a higher renal threshold for glucose, making it less effective.
What are the risk factors for Type 1 diabetes?
- Early-onset (age < 30 years)
- Familial
- Genetic predisposition
- Race/ethnicity: (African American, Native American, Hispanic)
What are the risk factors for Type 2 diabetes?
- Obesity
- Age > 30 years
- Previous impaired fasting glucose or glucose tolerance
- Hypertension
- HDL ≤ 35 mg/dL or triglycerides ≥ 250 mg/dL
- History of gestational diabetes or babies over 9 pounds
What are the acute complications of diabetes?
- Hypoglycemia
- Diabetic Ketoacidosis (DKA)
- Hyperglycemic Hyperosmolar Syndrome (HHS)
What is the management of hypoglycemia?
- Give 15 to 20 g of fast-acting carbohydrate
- Three or four glucose tablets
- 4 to 6 ounces of juice or regular soda
- Emergency measures: glucagon or dextrose IV if unconscious
What are the long-term complications of diabetes?
- Macrovascular: coronary artery disease, cerebrovascular disease, peripheral vascular disease
- Microvascular: diabetic retinopathy, nephropathy
- Neuropathic: peripheral neuropathy, autonomic neuropathies
What is the diagnostic finding for diabetes?
- Fasting blood glucose 126 mg/dL or more
- Casual glucose exceeding 200 mg/dL
What is the role of exercise in diabetes management?
- Lowers blood glucose
- Aids in weight loss
- Eases stress
- Maintains well-being
- Lowers cardiovascular risk
What are the categories of insulin?
- Rapid acting: lispro, aspart, glulisine
- Short acting: regular insulin
- Intermediate acting: NPH insulin
- Long acting: glargine
- Rapid-acting inhalation powder: Afrezza
When does Rapid Acting Insulin start working?
When does it peak?
Onset: 15-30 minutes
Peak: 30 minutes to about an hour/hour and a half
Aspart, Lispro, glulisine
When does Short Acting Insulin start working?
When does it peak?
Onset: 30-60 minutes
Peak: 2-3 hours
Regular
When does Intermediate Acting Insulin start working?
When does it peak?
Onset: 60-90 minutes
Peak: 4-12 hours
NPH
When does Long Acting Insulin start working?
When does it peak?
Onset: 3-6 hours
Peak: NO Peak
Glargine, Detemir
What is Latent Autoimmune Diabetes of Adults?
- Slower progression of autoimmune beta cell destruction
- Not insulin dependent in first 6 months of disease
What is the nurse’s role in dietary management of diabetes?
- Be knowledgeable about dietary management
- Communicate with dietician or other management specialists
- Reinforce patient understanding
- Support dietary and lifestyle changes
What is important to remember for Meal Planning with Diabetes management?
- Consider food preferences, lifestyle, cultural and ethnic backgrounds
- Review need for weight loss, gain, or maintenance
- Exchange lists
- Carbs - 50-60%
- Fat - 20-30%
- Plant proteins
- Increase fiber
What are exchange lists in Diabetes meal planning?
- 2 starches = 2 slices of bread; 1 cup of pasta; Hamburger Bun
- 3 meats = 2oz of turkey and 1 oz sliced cheese; 3 oz lean ground beef patty; 3 oz. boiled shrimp
- 1 vegetable = lettuce, tomato, onion; green salad; 1/2 cup plum tomatoes
- 1 fat = 1 tsp mayo; 1 tbsp salad dressing; 1 tsp olive oil
- 1 fruit = 1 medium apple; 1 1/4 cup watermelon; 1 1/4 cup strawberries
FREE items: unsweetened iced tea, mustard, pickle, hot pepper, diet soda, 1 tbsp ketchup, garlic, basil, etc.
What is important to know about the glycemic index?
Measurement of how fast foods can elevate blood sugar
- Combine starchy foods with protein and fat - slows absorption
- Raw or whole foods = lower GI
- Whole fruits > juices (due to fiber)
- Foods with sugars + slower absorbed foods = better GI
What is important to remember about alcohol and how it is metabolized?
- Absorbed before other nutrients
- Does NOT require insulin
- Large intake converts to fat
- Can contribute to DKA
- May hinder glyconeogenesis = alcohol on an empty stomach could lead to hypoglycemia
What should be cautioned with diabetic patients and exercise?
- Insulin decreases with exercise = should eat a 15g carbohydrate snack before moderate exercise to prevent hypoglycemia
- DM2 patients, not using insulin = probably don’t need extra food before exercise
- Monitor blood glucose closely
Recommendation is still 3 days a week
Who are good candidates to self measure blood glucose?
- Anyone on an insulin regimen (using insulin 2-4x/day or a continuous pump)
- Unstable diabetes
- A tendency to develop ketosis or hypoglycemia
- Anyone who becomes hypoglycemic without warnings
- Not taking insulin? Measure 2-3x per week, whenever suspecting hypo or hyperglycemia, when sick, under stress, or with any changes in medications, activity or diet
