Diabetes Mellitus: Nursing Management

Introduction

• Focus on nursing management for diabetes, specifically for NCLEX and nursing lecture exams.
• Visit registerednursern.com for a quiz testing your knowledge on this material.
• Part of an NCLEX review series on diabetic patients.

Nurse's Role in Managing Diabetes

• Education: Teach patients about diet, exercise, and medication.
• Medication Administration: Administer medications as prescribed.
• Assessment & Monitoring: Regularly monitor blood glucose levels.
• Triangle of Diabetes Management:
  • Diet
  • Medications
  • Exercise
  • Monitoring glucose levels

NCLEX Exam Focus

• Diet: Educate on appropriate dietary choices.
• Exercise: Best practices and monitoring blood glucose.
• Medication:
  • Insulin types and administration.
  • Oral medications for type 2 diabetes.

Dietary Management

• ADA Diet Guidelines:
  • Carbs: 45% (grains, starchy vegetables, sweets)
  • Fats: Limit to 20% (avoid saturated/trans fats)
  • Proteins: 15-20% (prefer lean meats, plant-based options)

Exercise Guidelines

• Best Type: Aerobic exercises (walking, swimming)
• Pre-Exercise:
  • Check blood glucose.
  • Consume snacks if glucose <100 mg/dL.
• During/After Exercise:
  • Monitor blood glucose levels.
  • Avoid exercise if glucose >250 mg/dL with ketones.

Recognizing Hypoglycemia

• Symptoms: Sweaty, clammy, confused, tremors.
• Mnemonic: "I'm sweaty, cold, and clammy, please give me some candy."

Recognizing Hyperglycemia

• Symptoms: Polyuria, polyphagia, polydipsia.
• Mnemonic: "I'm hot and dry, I must be on a sugar high."

Medications

• Oral Medications:
  • Sulfonylureas: Glyburide, Glipizide. Watch for hypoglycemia. No alcohol.
  • Meglitinides: Take with the first bite of food.
  • Biguanides (e.g., Metformin): Hold 48 hours before surgery.
  • Alpha-Glucosidase Inhibitors: Take with the first bite of food.
  • Thiazolidinediones (TZDs): Monitor liver and heart function.
• Drugs Causing Hypo/Hyperglycemia:
  • Beta-blockers, alcohol, aspirin, MAO inhibitors may cause hypoglycemia.
  • Thiazides, glucocorticoids, estrogen therapy may cause hyperglycemia.

Insulin Management

• Types of Insulin:
  • Rapid (e.g., Humalog, Novolog)
  • Short (e.g., Regular)
  • Intermediate (e.g., NPH)
  • Long (e.g., Lantus, Levemir)
• Administration:
  • Subcutaneous, rotate sites.
  • Only regular insulin can be given IV.
• Mixing Insulin:
  • "Clear to Cloudy" (Regular to NPH)

Insulin Onset, Peak, and Duration

• Rapid: Onset 15 min, Peak 1 hr, Duration 3 hrs.
  • Mnemonic: "15 minutes feels like an hour during three rapid responses."
• Short: Onset 30 min, Peak 2 hrs, Duration 8 hrs.
  • Mnemonic: "Short staff nurses went from 30 patients to 8 patients."
• Intermediate: Onset 2 hrs, Peak 8 hrs, Duration 16 hrs.
  • Mnemonic: "Nurses play hero 2 to 16-year-olds."
• Long: Onset 2 hrs, No peak, Duration 24 hrs.
  • Mnemonic: "The two long nursing shifts never peaked but lasted 24 hours."

Phenomena and Effects

• Dawn Phenomenon: Hyperglycemia in the early morning. Treat with NPH at bedtime.
• Somogyi Effect: Nocturnal hypoglycemia causing rebound hyperglycemia. Treat with bedtime snacks or lower bedtime insulin dose.

Conclusion

• Test your knowledge with the quiz on registerednursern.com.
• Continue learning with other videos in the series.