Below are review notes for Diabetes Mellitus to help you study for the NCLEX exam or your nursing lecture exams.

As the nurse taking care of the diabetic patient, you must know how to properly care for them, especially newly diagnosed diabetics. The nurses role include educating, assessing, planning, administering medications, and evaluating treatment.
These NCLEX review notes will cover:

• Diet
• Exercise
• Oral Diabetic Medications
• Insulin
• Mnemonics

After reviewing these notes, don’t forget to take the Diabetes NCLEX quiz.

Lecture on Diabetes Mellitus for NCLEX Review

Diabetes Nursing Management

Nurse’s role: educating, monitoring, and administering (medications)

Teach patient to follow the Triangle of Diabetes Management

**Diet, medications, and exercise all work together while monitoring blood glucose

Example: Patient wants to make sure their diet is balanced with their medication (insulin/oral meds) and they use exercise to manage glucose levels (doing all this while monitoring blood glucose).

As the nurse you will be educating the diabetic…so for the NCLEX know education pieces like:

• Diet, exercising, oral medications, giving insulin (peak times), drugs that increase blood glucose and lower glucose etc.

Diabetic Diets

DIET: Diets are individualized due to physical activity and medication therapy (they always need tweaking)…recommend following American Diabetic Association Diet (ADA)

Limitation of the following:

• Carbs (45-60%) grains, vegetables with starches potatoes, corn, sweets…cookies, soda, dried beans, milk)
• Fats (<20 %)….limit unhealthy fats saturated, trans fats, cholesterol: lard, gravies, whole milk, bologna, hot dogs, sausage, processed foods hydrogenated oils…concentrate on mono & polyunsaturated avocadoes, olives, peanuts, nuts
• Proteins (15-20%) meats don’t increase the glycemic index: meats chicken, turkey, fish, plant based beans, peas, low fat cheese, eggs whites

Exercising Management

Exercise:  Aerobic the best (helps the body use insulin) ex: cardio running, walking, swimming etc.

Teach patient signs of hypoglycemia & hyperglycemia

Signs of Hypoglycemia:

• “I’m sweaty, cold, and clammy….give me some candy”
  • “Sweating, clammy, confusion, light headedness, double vision, tremors”

Signs of Hyperglycemia: Three P’s

• Polyphagia
  • I’m hot and dry…I must be on a sugar high!
• Polydipsia
• Polyuria

• Always check blood sugar prior to exercising: if lower than 100 eat a small carb snack and carry SIMPLE carbs with you while exercising in case of hypoglycemic attack
  • Example of simple carbs:  hard candy, honey, crackers/graham crackers, fruit juice

****If patient plans on exercising for an extended period of time, check glucose prior, during, and after.

****If blood glucose is higher than 250 with ketones present in urine prior to exercise avoid exercise until glucose and ketones stabilize.

Diabetic Medications

NCLEX specific:

Oral medications (for patients with Type 2 diabetes when exercise and diet doesn’t work to control blood glucose):

• Sulfonylureas: ides zides, mides, rides” (most common) stimulate beta cells in pancreas to make insulin  (Glyburide, Glipizide, Diabinese, Amaryl) AVOID ETOH….extreme hypoglycemia
• Meglitinides: “glinide” Ex: repaglinide “Prandin” stimulate beta cells in pancreas to make insulin…instruct pts to take first bite with meal
• Biguanides: Metformin (Glucophage)….causes the liver to decrease its stores of glucose. Watch out if patient is scheduled for surgery/procedure (heart cath)…stop for 48 hours and watch renal function…diarrhea
• Alpha-glucoside inhibitors: Precose, Glyset lower blood sugar by slowly down the breakdown of starchy foods in the GI system which helps slowly rise the blood sugar… instruct pts to take first bite with meal
• Thiazolidinedione: “glitazone” reduce glucose production in the liver:  Actos/Avandia watch liver function and heart function increase risk of MIs

Medications that cause hypoglycemia

• Remember from the hypertension lecture that Beta Blockers (mask symptoms of hypoglycemia)
• Other medication that cause it: ETOH, ASA, Sulfonylureas (medications used to treat type 2: Glyburide, Glipizide, Diabinese), and MAO inhibitors (meds for depression) , Bactrim (common antibiotic)

Medications that cause hypergycemia

Thiazide diuretics (HCTZ), Glucocorticoids (Prednisone, Hydrocortisone), estrogen therapy

Insulin

It is used for Type 1 regularly, and sometimes for Type 2 diabetics if the patient is experiencing stress on the body like surgery or illness.

Know the categories of insulin. Example: whether they are rapid, short, intermediate, long acting and the onset, peak, and duration.

Note: Peak is the most susceptible time for hypoglycemia

Insulin Mnemonics

Note that if you use the word insulin you can divide the word and separate it into specific categories of insulin types. Watch the lecture above for a full in-depth explanation about this mnemonic.

Rapid-Acting Insulin:

“15 minutes feels like an hour during 3 rapid responses.”

• Onset: 15 minutes
• Peak: 1 hour
• Duration: 3

Short-Acting Insulin:

“Short-staffed nurses went from 30 patient to (2) 8 patients.”

• Onset: 30 minutes
• Peak: 2 hours
• Duration: 8 hours

Intermediate-Acting Insulin:

“Nurses Play Hero to (2) eight 16 year olds.”

• Onset: 2 hours
• Peak: 8 hours
• Duration: 16 hours

Long-Acting Insulin:

“The two long nursing shifts never peaked but lasted 24 hours.”

• Onset: 2 hours
• Peak: NONE
• Duration: 24 hours

Key Points to Remember about Administering Insulin

• Rotate sites: do not use the same site more than once in a 2-3 week period this PREVENTS LIPODYSTROPHY (pitting of subq fat)
  • Sites include: abdomen, arms, and thighs
• When mixing insulin (clear to cloudy) clean=regular, cloudy=NPH
• Don’t massage site after administration increase hypoglycemia due to absorption

Dawn Phenomenon:

Watch for Dawn phenomenon (hence the name dawn…crack of dawn means the waking hours) this is a time when the body will increase the blood sugar in preparation for waking.  However, when you have insulin problems (not enough of it) the increased blood sugar causes HYPERGLYCEMIA

Typical time: 5am to 8 am

Treatment: may need a night time dose of NPH to counteract.

Somogyi Effect:

Somogyi effect (remember S in Somogyi for sleeping hours): This is a drop in blood sugar at the hours of 2 to 3 am.  This happens when the body releases hormones such as coristol, catecholamines, growth hormones to increase the blood sugar. However, in diabetics the body can’t cope with the increased blood sugar and the sugar will be elevated.

Treatment: Eat a bedtime snack….a dose of bedtime insulin will prevent it from dropping so low or decreasing insulin amounts at night

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