Diabetes II

Med Surg: Endocrine

Treatment - Patient Education Complications

D–DIET –Low carbs KIDNEY–Nephropathy (High Creatinine OVER 1.3)

AVOID: Simple Sugars (soda, candy, white bread/rice, juices) EYE–Retinopathy (blind)
• Good High Fiber = BROWN (bean, rice, bead, peanut HEART–HTN & Atherosclerosis
butter) BRAIN–CVA (strokes)
“whole wheat/grain/milk”
• Bad Low fiber = White (bread, rice, bread potatoes (fries),
NERVES–Neuropathy (loss of feeling)
low fat milk)

D–DIABETIC FEET “Delicious Feast for bacteria”

GOAL: Clean, Dry, Injury Free
AVOID
F–Flip Flops, high heels, Nylon,
O–OTC corn removal
O–Overly HOT (baths, pads etc.)
Oral Hypoglycemics (Type 2 Only)
T–Toe Injuries — cut nails STRAIGHT
NCLEX KEY WORDS: 1. DIET & EXERCISE BEFORE oral meds and insulin
Daily inspection — NOT weekly 2. METFORMIN–Minimal chance of Low Sugar “hypoglycemia”
Shoes fit properly — NO sandals 1. Weight Loss
SOFT Cotton Socks — NOT nylon 2. Lactic Acidosis: NO Alcohol + STOP 48 hours before and
Nails trimmed–cut straight — NOT curved angles after cath
Non healing skin wounds — Report to HCP (Dr.) IV Contrast = Kills Kidney
NO callous removal 3. GLIPIZIDE GLYBURIDE–Heart can DIE (bad for CHF)
NO heavy Powder — light powder LOW blood sugar (Avoid alcohol “ETOH” = hypoglycemia)
NO rubbing feet hard “vigorously” TOXIC: Renal, Liver & elderly population
NO HOT baths or HOT pads — warm is ok Sun Burns = sunscreen & protective clothing
4. THIAZOLIDINEDONE (TZD) Pioglitazone (ONE heart)
Insulin Types NO Heart Failure patients–new pitting edema, crackles (lungs)
NO Liver failure patients “Cirrhosis” “Liver Failure”

LONG ACTING NPH REGULAR RAPID 7 Insulin Tips

NO Peak iNtermediate Ready to go IV
Aspart/Lispro/ 1. Peaks + Plates = Food during PEAK times (prevent HYPOgly=brain die)
NEVER IV drip Glulisine
NO Mlx Regular goes 2. NO Peak NO Mix = Long acting “old guys”–Detemir & Glargine
or IV bag
• Detemir right into the vein 3. IVP or IVPB ONLY = Regular insulin “ready to go IV”
Mix clear to
• Glargine ONLY IV insulin 4. Draw Up: Clear to Cloudy “you want CLEAR days before cloudy ones”
cloudy
• Levemir = 5. Rotate locations-Macarena-BEST on abdomen
Given 2x per
Long acting
day (2 inches from: Umbilicus, Naval, “belly button”)
PEAK 6. DKA - Type 1–“sick days”–YES INSULIN without food!!!
30-90 minutes
7. Hypoglycemia (70 or LESS)
15 minute Awake = Ask them to Eat (soda, juice, low fat milk)
PEAK ONSET
2-4 hour Sleeping = Stab with IV D50 (dextrose 50)
PEAK
MOST DEADLY "Unresponsive" "Responsive ONLY to pain"
4-12 hour

NO PEAK

Aspart, lispro, glulisine

Regular
PEAKS = BEST CHOICE
Insulin levels

NPH

Detemir
Glargine

0 2 4 6 8 10 12 14 16 18 20 22 24
Hours
PEAK TIMES = Hypoglycemia risk 70 or Less
Hypogly brain will DIE NCLEX TIP