Nursing Management of Diabetes Mellitus

Introduction

• Focus: Nursing management for diabetes mellitus (DM) for NCLEX and nursing exams.
• Previous video: Covered pathophysiology, causes, complications, types, and nursing assessment.
• Website resource: Take a free quiz on registerednessrn.com.

Nurse's Role in DM Management

• Education, medication administration, assessment, and monitoring.
• Follow the "Triangle of Diabetes Management":
  • Diet
  • Meds
  • Exercise
  • Monitoring
• For Type 2 diabetics, monitoring diet and exercise may eliminate the need for medication.

NCLEX Focus Areas

• Diet: Educating on appropriate foods and diet management.
• Exercise: Appropriate exercise types and glucose monitoring.
• Insulin therapy: Understanding insulin types, complications, and management.
• Pharmacology: Knowing drugs that cause hypo/hyperglycemia and Type 2 diabetic oral medications.

Diet in Diabetes

• ADA Diet Guidelines:
  • Carbohydrates: At least 45% from grains, starchy vegetables, sweets (hidden carbs).
  • Fats: Limit to max 20%, focus on healthy fats (monounsaturated, polyunsaturated).
  • Proteins: 15-20%, prefer chicken, turkey, fish, plant-based proteins.

Exercise for Diabetics

• Aerobic Exercise: Recommended for insulin utilization.
• Pre-exercise:
  • Check blood sugar.
  • If < 100, eat a snack to avoid hypoglycemia.
  • Carry simple carbs for potential hypoglycemic episodes (hard candy, juice).
• Signs of Hypoglycemia: Sweaty, clammy, confusion, hunger, etc.
• High Blood Sugar: Avoid exercise if glucose > 250 mg/dL with ketones.

Medications

• Oral Medications for Type 2 Diabetes:
  • Sulfonylureas: Stimulate insulin production, avoid alcohol.
  • Meglitinides: Take with food, stimulate beta cells.
  • Biguanides (Metformin): Decrease liver glucose production, watch renal function.
  • Alpha-glucosidase inhibitors: Take with first bite of food.
  • Thiazolidinediones: Decrease liver glucose, monitor heart and liver function.

Drugs Affecting Blood Sugar

• Causing Hypoglycemia: Beta-blockers, alcohol, aspirin, sulfonylureas, MAO inhibitors, Bactrim.
• Causing Hyperglycemia: Thiazides, glucocorticoids, estrogen, oral contraceptives.

Insulin Management

• Types of Insulin:
  • Rapid (Humalog, Novolog)
  • Short (Regular, Humulin R)
  • Intermediate (NPH)
  • Long (Lantus, Levemir)
• Admin Tips:
  • Subcutaneous injection, rotate sites to avoid lipodystrophy.
  • Clear to cloudy when mixing (Regular before NPH).
• Phenomenons:
  • Dawn Phenomenon: High morning glucose, counteract with nighttime NPH.
  • Somogyi Effect: Night hypoglycemia, manage with bedtime snack or lower insulin.

Insulin Mnemonics

• Rapid (15 min, 1 hr, 3 hr): "15 minutes feels like an hour during three rapid responses."
• Short (30 min, 2 hr, 8 hr): "Short-staffed nurses went from 30 patients to eight."
• Intermediate (2 hr, 8 hr, 16 hr): "Nurses play hero 2 to 8 years."
• Long (2 hr, no peak, 24 hr): "Two long nursing shifts never peaked but lasted 24 hours."

Conclusion

• Review knowledge with quizzes and other video series on diabetes management.
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