NR325 Adult Health II Exam #1 ROK.

NR325 Adult Health II
Exam #1 ROK

, NR325 Adult Health II
Exam #1 ROK

Diabetes Mellitus

Type 1 Type 2
 Results from autoimmune destruction of beta cells  Exact cause remains unknown
 Has a genetic predisposition  Genetic predisposition
 More common in men  Can occur at any age
 Can occur at any age but usually occurs in children &  More common in obesity, older adults, blacks,
adolescents Hispanic Americans, Native Americans
 Also characterized by hyperglycemia & ketosis

Clinical Manifestations:
 3 “Ps” Clinical Manifestations:
o Polyuria  Polyuria
o Polydipsia  Polydipsia
o Polyphagia  Blurred vision
 Weight loss  Fatigue
 Malaise  Paresthesias (numbness, tingling, sensitivity)
 Fatigue  Skin infections

Hyperglycemia Hypoglycemia
S/S: S/S:
 Polydipsia  Headache
 Polyuria  Nausea
 Polyphagia  Sweating
 Blurred vision  Tremors
 Weakness  Lethargy
 Weight loss  Hunger
 Syncope  Confusion
 Slurred speech
Nursing Actions:  Tingling around mouth
 Encourage H2O intake  Anxiety, nightmares
 Check blood glucose frequently
 Assess for ketoacidosis: Nursing Actions:
-Urine ketones  Usually occurs rapidly & is potentially life-threatening; treat
-Urine glucose immediately with complex carbohydrates (CHO)
-Administer insulin as directed  Example fast acting carbohydrates:
 One tube glucose gel; 120-189 mL fruit juice or cola; 10-16
jelly beans; 10 gum drops; 3 pieces of hard candy (Jolly
Ranchers); 5-7 pieces Lifesaver type candy
 Check blood glucose (may seize if <40).


 Diagnostic & Laboratory test findings:
o Elevated random &/or fasting blood glucose
o Possible positive serum ketones
o Elevated glycosylated hemoglobin (HgBA1C)
o Abnormal oral GTT
o Urine positive for glucose
o Possible positive ketones or acetone

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, NR325 Adult Health II
Exam #1 ROK
 Therapeutic management: consists of frequent monitoring of blood & capillary glucose, individualized diet plan, oral antidiabetic
med &/or insulin injections, & exercise plan.


Normal HgBA1C level is <6.5; >7.0 indicates diabetes.


Insulin Therapy

Type Name Onset Peak Action Duration Nursing Implications
 Human Insulin Lispro
(Humalog)
Rapid Acting 15-30 mins 30-90 mins 3-5 hrs.  Give within 15 mins of a meal (Lispro
 Aspart (Novolog) & Aspart)

 Glulisine (Apidra)
 Regular insulin
Short Acting (human) (Humulin 30-60 mins 2-3 hrs. 5-7 hrs.  Regular insulin may be given IV
R, Novolin R)
 Not to be given IV
 Isophane insulin  Mixtures combine rapid-acting insulin
Intermediate (Human) (Humulin 1-2 hrs. 4-6 hrs. 14-24 hrs. with intermediate-acting NPH insulin
Acting N, Novolin N) in a 30% regular with 70% NPH
proportion or at 50/50 combination
• Not to be given IV.
• Recommended: give once daily
(subcutaneous) at bedtime.
• In some cases, given two times a day.
• Acts as basal insulin.
• Glargine (Lantus) • • Caution: Solution is clear, but bottle is
Long Acting Detemir (Levemir) 1 hr. Peakless 24 hr. distinctly different from regular
insulin.
• Do not confuse insulins.
• Do not shake solution.
• Do not mix other insulins with Lantus.
• Use cautiously if patient is NPO.
• Humalog 75/25 10-30 mins • For all premixes: Offer when food is
• Humalog 70/30 readily available.
Premix Varies 1-4 10-16 hrs. • 25% Lispro/75% Humulin N (NPH)
• NovoLog 70/30 5-10 mins hrs. • 30% Regular/70% NPH
• Humalog 50/50 • 30% Aspart /70% NPH




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