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.
Dietary Management Goals•Maintain the pleasure of eating; include personal and cultural preferences•Promote exercise and activity •Achieve and maintain BMI <25•Prevent wide fluctuations of blood glucose levels•Decrease serum lipids, if elevated
Role of the Nurse•Be knowledgeable about dietary management•Communicate important information to the dietician or other management specialists•Reinforce patient understanding•Support dietary and lifestyle changes
Meal Planning•Consider food preferences, lifestyle, usual eating times, and cultural and ethnic background•Review diet history and need for weight loss, gain, or maintenance•Caloric requirements and calorie distribution throughout the day; exchange lists •Carbohydrates: 50% to 60% carbohydrates; emphasize whole grains•Fat: 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
Glycemic Index•Combining 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.
Other Dietary Concerns•Alcohol•Nutritive and nonnutritive sweeteners•Reading labels
Exercise•Lowers blood sugar •Aids in weight loss•Lowers cardiovascular risk•Refer to Chart 51-4
Exercise Precautions•Exercise elevates blood sugar levels; insulin must be adjusted•Insulin normally decreases with exercise; patients on exogenous insulin should eat a 15-g carbohydrate snack before moderate exercise to prevent hypoglycemia•Potential postexercise hypoglycemia: refer to Chart 51-5•Need to monitor blood glucose levels •Gerontologic considerations
Insulin Therapy•Blood glucose monitoring •Categories of insulin: refer to Table 51-3–Rapid acting–Short acting–Intermediate acting–Very long acting•Inhaled insulin
Normal Pancreatic Insulin Release
One Injection Per Day
Two Injections Per Day—Mixed
Three or Four Injections Per Day
Educating Patients in Insulin Self-Management•Use and action of insulin•Symptoms of hypoglycemia and hyperglycemia–Required actions •Blood glucose monitoring•Self-injection of insulin•Insulin pump use
Oral Antidiabetic Agents•Used for patients with type 2 diabetes who require more than diet and exercise alone•
You've reached the end of your free preview.
Want to read all 144 pages?
- Spring '14
- Nursing, blood glucose, Blood sugar, REFER