| Diet & Lifestyle | Macrovascular and Microvascular complications | DKA and HHNS | Blood Glucose Monitoring | Tony |
|---|---|---|---|---|
|
-improves BG control
-reduces body fat -helps keep pancreas, kidneys, eyes and nerves healthy -reduces risk of MI, CVA, and death
What are three long term benefits of physical activity?
|
1. Retinopathy
2. Nephropathy 3. Neuropathy
Name the three main microvascular complications
|
The presence of ketones in the blood
What is the main difference between DKA and HHNS?
|
-before meals
-before exercise -PRN if suspected hypo or hyper-glycemia
When should you test your blood sugars?
|
-a macrovascular complication, PVD
Tony's left calf pain may be an indication of what?
|
|
-controls BG levels -control appetite -controls cholesterol -lowers risk for developing DM2 and heart disease
Name three reasons why to chose foods with a low GI?
|
Coronary artery disease
Peripheral vascular disease Cerebral vascular disease
What are the major macro vascular complications
|
-If you have two BG readings of over 14mmol/L
-Intese thirst -abdominal pain -excessive tiredness -nausea and vomiting
When should you test for ketones?
|
1. polydipsia
2. polyuria 3. polyphagia
What are the three P's of hyperglycemia?
|
-severe drowsiness
-incoherent speech -unsteady gait -kussmaul breathing (RR 32) -acetone odour to breath -BG 30 mmol/L -Temp increased - Nausea and vomiting - Voided 250mmol conc. urine POSITIVE for ketones
What signs of DKA does Tony exhibit on day one?
|
|
-BG < 4mmol/L -BG > 14mmol/L with ketones -BG > 17mmol/L with or without ketones
Name two scenarios where exercise may be dangerous?
|
1. Check feet daily
2. Wash feet daily 3. Keep skin soft 4. Trim toenails (not too short) 5. Proper shoes and socks 6. Keep blood flowing to feet 7. Protect your feet from hot/cold 8. Regular vista to the HCT 9. Activity and Nutrition 10. Pay attention
Name five tips for good foot care, give your rational
|
-empty the ballade completely, discard urine
-drink 1-2 glasses of water -urinate into a clean dry container -take a reagent strip and dip it in the sample -let air dry for 15 seconds -compare the colour of the strip to the chart on the container *high i
How do you test for ketone bodies?
|
1. dirty meter
2. incorrect calibration (or not calibrated) 3. expired test strips 4. strips exposed to humidity/extreme temp 5. not enough blood
What three things can cause an inaccurate reading?
|
-sleeping 4-6 hours per night
-not dealing with stressors immediately (letting problems pile up) -problems with employment -trouble coping with new environment (adjusting to move) -not discussing stressors
What are some signs of anxiety Tony display's?
|
|
-start 4 days per week and 10 mins per session and increase to 5 days per week for a minimum of 30mins per session
How often should you perform aerobic exercise?
|
-injury (slight)
-digestive problems (constipation and diarrhea) -bladder problems (frequency, urgency, incontinence) -erectile disfunction -accelerated/irregular heart beat
What symptoms of neuropathy did we mention should be reported to your physician?
|
-older population with more co morbidities effecting hydration ; kidney disease, CVA complications ect.
Why does HHNS have a higher mortality rate?
|
Adrenergic
• Shakiness • Irritability • Nervousness • Tachycardia • Tremors • Hunger • Diophoresis • Pallor • Parathesias Neuroglycopenic • Headache • Mental illness • No concentration • Slurred speech • Blurred vision • Confusion • Irrational behavior
Name three adrenergic and three neuroglycopenic signs of hypoglycemia
|
- frequent and severe hypoglycaemia episodes may lead to a decrease in warning signs; shakiness, irritability, tachycardia, diaphoresis ex. encouraging frequent blood glucose monitoring inject insulin according to Dr. orders have a regular
How could you explain hypoglycaemic unawareness to Tony? Provide an example of an intervention
|
|
- 1 slice of white bread, 1/2 bagel
- 1/2 cup cooked pasta - 1 medium pear - 1 cup low fat milk - 2 tablespoons peanut butter - 1 slice bacon - 1 large egg
Come up to the board you have 30 seconds to write as many 15g carb examples are you can
|
- Statin therapy ex. atrovastatin, pravastatin, rosuvastitin
You want to lower LDL cholesterol by 50% or 2 mmol/L
What kind of medication should a diabetic be on to control blood lipids?
|
-drink 250ml of water every hour to hydrate
-take extra doses of insulin (according to Dr. orders) -call physician or go to the emergency department if persistent excess of ketones -check BG levels frequency
What should be done if excess ketone bodies are detected?
|
Hep C in the cap of the lancet... not the needle
What type of disease is often spread through sharing of BG monitors?
|
Femoral-popliteal bypass procedure
-from atherosclerosis causing PVD (macro vascular) -re vascularizing the limb through an artificial or analogous vein graft
What does fem pop stand for? What type of complication is it and what is it?
|
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