Diabetes Part 2 Notes

• Interprofessional Care: Provider Insulin Plans include Basal-Bolus plan, Mealtime insulin: rapid or short-acting insulin, and Immediate insulin.
• Taking Nursing Action: Mealtime insulin is a small bolus with as little as 1 unit of rapid or short-acting insulin before the meal.
• The dose of mealtime insulin is based on the glucometer reading.
• The dose scale of mealtime insulin can vary from client to client.
• Taking Nursing Action:Mealtime insulin can be mixed with NPH.
• If the medications are in an insulin pen(s), the nurse can use the sliding scale for the bolus dose needed/not needed.
• The client, who weighs 54 kg, has a prescription for basal and bolus insulin at breakfast and bedtime: NPH 18 units SC at breakfast, lispro units SC per bolus scale with meals and bedtime, NPH 9 units SC at bedtime.
• Blood glucose intervention depends on the level: Less than 70, Rule of 15; 71-199, No intervention; 200-249, 2 units of insulin lispro; 250-299, 4 units of insulin lispro; 300-349, 6 units of insulin lispro; 350-399, 8 units of insulin lispro; 400-449, 10 units of insulin lispro.
• Other drugs that can affect blood glucose levels include birth-control pills, steroids, and ETOH.
• The Somogyi effect and Dawn phenomenon are related to blood glucose levels.
• Oral & Noninsulin Injectable Agents used in type 2 DM work differently depending on their classification and may be used in combination, combination tablets, or with insulin.
• Nutrition Therapy for type 2 DM includes managing carbohydrate intake to 45% of daily intake, limiting fat and cholesterol, protein to 15%-20%, and limiting high fructose corn syrup & sugar sweetened beverages.
• Exercise increases insulin sensitivity and has a direct effect on lowering blood sugar levels.
• Blood Glucose Monitoring in type 2 DM can be conducted with portable meters or continuous glucose meters (CGM) and provides daily monitoring and fluctuations.
• Transplant may be an option for someone with type 1 DM if in end stage renal disease & will have a coinciding kidney transplant, or meet other criteria.