Treatment Goal Maintain Normal Blood Glucose Levels Hgb A1c 7 Intensive control

Treatment goal maintain normal blood glucose levels

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Treatment Goal: Maintain Normal Blood Glucose Levels (Hgb A1c <7%)Intensive control, defined as three or four insulin injections per day or continuous subcutaneous insulin infusion, insulin pump therapy plus frequent blood glucose monitoring, and weekly contacts with diabetic educators, dramatically decreases development and progression of complications such as retinopathy, nephropathy, and neuropathy.
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Dietary Management GoalsMaintain the pleasure of eating; include personal and cultural preferencesPromote exercise and activity Achieve and maintain BMI <25Prevent wide fluctuations of blood glucose levelsDecrease serum lipids, if elevated
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Role of the NurseBe knowledgeable about dietary managementCommunicate important information to the dietician or other management specialistsReinforce patient understandingSupport dietary and lifestyle changes
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Meal PlanningConsider food preferences, lifestyle, usual eating times, and cultural and ethnic backgroundReview diet history and need for weight loss, gain, or maintenanceCaloric requirements and calorie distribution throughout the day; exchange lists Carbohydrates: 50% to 60% carbohydrates; emphasize whole grainsFat: 20% to 30%, with >10% from saturated fat and <300 mg cholesterol; protein: 10% to 20%Fiber: 25 g daily; refer to Table 51-2
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Glycemic IndexCombining starchy foods with protein and fat slows absorption and glycemic response.Raw or whole foods tend to have lower responses than cooked, chopped, or pureed foods.Eat whole fruits rather than juices; this decreases glycemic response because of fiber (slowing absorption).Adding food with sugars may produce lower response if eaten with foods that are more slowly absorbed.
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Other Dietary ConcernsAlcoholNutritive and nonnutritive sweetenersReading labels
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ExerciseLowers blood sugar Aids in weight lossLowers cardiovascular riskRefer to Chart 51-4
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Exercise PrecautionsExercise elevates blood sugar levels; insulin must be adjustedInsulin normally decreases with exercise; patients on exogenous insulin should eat a 15-g carbohydrate snack before moderate exercise to prevent hypoglycemiaPotential postexercise hypoglycemia: refer to Chart 51-5Need to monitor blood glucose levels Gerontologic considerations
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Insulin TherapyBlood glucose monitoring Categories of insulin: refer to Table 51-3Rapid actingShort actingIntermediate actingVery long actingInhaled insulin
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Normal Pancreatic Insulin Release
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One Injection Per Day
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Two Injections Per Day—Mixed
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Three or Four Injections Per Day
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Insulin Pump
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Educating Patients in Insulin Self-ManagementUse and action of insulinSymptoms of hypoglycemia and hyperglycemiaRequired actions Blood glucose monitoringSelf-injection of insulinInsulin pump use
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Oral Antidiabetic AgentsUsed for patients with type 2 diabetes who require more than diet and exercise alone
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  • Spring '14
  • AileenFitzpatrick
  • Nursing, blood glucose, Blood sugar, REFER

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