what is the goal setting for diabetic patient?
- achieve and maintain premeal glucose in (4-7 range) within3 days
- target Hba1c below 7%
what is the flow of diabetes check if after 2 test cannot cfm
(not sure of this medthod)
first do fasting : if more than 6 (high)
do oral gtt
impaired fasting glucose : less then or equal to 7.8
impaired glucose tolerance : 7.8-11
diabetes melletus : more than or equal to 11
what are the things to take note for oral GTT
- fast patient 8-14 hours overnight
- performed in the morn after at least 3 days of restricted diet (greater than 150g of carb daily), normal physical activities
- collect 3ml of blood
- administer 75g anhydrous glucose orally over 5 mins
- collect blood sample again after 2 hours
what to do if Hba1c less than 7% (mild)
medical nutrition, therapy exercise and patient education
metformin (monotherapy)is an option
what to do if Hba1c 7-9%
metformin 1st line of drug
alternative therapy
- sulfonylurea + DPP 4 inhibitor
- Sulfonylurea + Thiazoldinedione
what to do if Hba1c more than 9%
metformin plus 2nd agent
alternative : start insulin therapy
for all hba1c high patient what do you need to do?
- reevaluate in a timely manner
2. lifestyle modification
when should urine and blood ketone monitoring be done?
during sustained hyperglycemia ( blood glucose more than 14 ) in patients with type 1 diabetes especially during acute illness
blood»> urine
when is self monitoring of blood glucose needed?
- type 1 or 2 diabetes who are using insulin
- type 2 diabetes who are not treated with insulin but are at risk of developing hypoglycemia, pregnant, acute illness, failed to achieve glycemic goals, undergoing fasting
when is hba1c monitoring needed?
- routinely in all patients with diabetes at initial assessment
- 3-4 monthly in patients with unstable glycemic control , failure to meet treatment goals, recent adjustment in therapy or intensive insulin therapy
- 6monthly with stable glycemic control and who are meeting treatment goals
what to do when patient is diagnosed with dka ? all situations
start IV fluid 1liter of 0.9% Nacl per hour
what to do when there is severe hypovolemia ? in dka patient
administer 0.9% Nacl (1 liter per hour)
what to do when there is mild hypovolemia? in dka patient
determine the serum NA level in the body
what to do when there is high - normal Na level? in dka patient
0.45 % Na cl (250-500ml per hour)
when serum glucose reaches 200mg/dl (11.1) change to
5% dextrose with 0.45% Nacl at 15-250ml/hour
what to do when serum Na level is low ? in dka patient
administer 0.9% Nacl (250-500ml per hour)
when serum glucose reaches 200mg/dl (4.4) change to
5% dextrose with 0.45% Nacl at 15-250ml/hour
what to do for cardiogenic shock? in dka patient
hemodynamic monitoring / pressor
what to do if potassium level is less than 3.3 LOW ? (dka patient)
hold insulin and give 20-40 K per hour until K is more than 3.3
what to do if potassium level is 3.3-5.3 medium ? (dka patient)
give 20-30 of K in eacg liter of IV fluid to keep serum K between 4-5
what to do if potassium level is more than 5.3 ? (dka patient)
do not give K but check serum K every 2 hours
what to do if patient Ph is less than 6.9 ?
dilute NaHCO3 (100mol) in 400ml H20 with 20KCL infuse over 2 hours
repeat NaHCO3 administration every 2 hours until PH more than 7
Monitor serum K every 2 hours
what is preoperative care ?
begins with the decision to perform surgery and continue until the client has reached the operating table
what is intraoperative care?
entire duration of the surgical procedure until transfer of patient to recovery area
what is post operative care?
begins with admission to recovery area and continues until the client receives follow up evaluation at home or is discharged to rehabilitation unit
what is involved in preoperative care ?
- informed consent
- pre operative checklist
- nil by mouth
- pre operative teaching
