Diabetic ManagementBy effectively treating the diabetic patient while he/sheis in the hospital we can impact their care at...
Diabetic Management (cont)Insulin should never be held if the patient is eating and the bloodsugar is within normal rangeP...
Diabetic Management (cont)Supplementation is not necessary until blood glucose dipsbelow 70The standard of care should ref...
Diabetic Management (cont)For blood glucoses 49 and below• Give 30 grams of rapid absorbing carbohydrates• 8 oz juice or 8...
Diabetic Management (cont) Blood glucose testing occurs 30 minutes prior to meal delivery While the timing may vary from...
Diabetic Management (cont)Accepting hyperglycemia• Due to fear of hypoglycemia, both nurses and patients often  accept hig...
Diabetic Management (cont)Education• A key piece of nursing is empowering our patients with knowledge  that will help them...
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Diabetic management 2012

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Diabetic management 2012

  1. 1. Diabetic ManagementBy effectively treating the diabetic patient while he/sheis in the hospital we can impact their care at homeOptimal diabetic management during hospitalizationspeeds recovery and reduces costsCommon Mistakes  Holding insulin inappropriately  Over supplementation of hypoglycemia  Inappropriate timing of blood glucose testing, meds, and meals  Accepting hyperglycemia without intervention  Failing to educate patients and families
  2. 2. Diabetic Management (cont)Insulin should never be held if the patient is eating and the bloodsugar is within normal rangeParticularly with basal insulin (Lantus/Levemir), the nurse isdepriving the patient of an entire day of blood glucose coverageWhile NPO patients should still receive basal insulin(Lantus/Levemir), rapid-acting meal time doses (Novolog orRegular) should be held in the absence of meal consumption.Basal insulin is designed to mimic the body’s natural metabolismand actually reduce the risk of hypoglycemia compared to otherinsulin forms
  3. 3. Diabetic Management (cont)Supplementation is not necessary until blood glucose dipsbelow 70The standard of care should reflect the Rule of 15• 15 grams/15 minutes• For blood glucoses 50-69• Provide 15 grams of rapid absorbing carbohydrates• 4 oz juice or 4 oz of regular - not diet – soda or 8 oz of fat free milk• Recheck in 15 minutes• Repeat until blood glucose reaches 70 mg/dl
  4. 4. Diabetic Management (cont)For blood glucoses 49 and below• Give 30 grams of rapid absorbing carbohydrates• 8 oz juice or 8 oz of regular - not diet – soda• Recheck in 15 minutes• These amounts are ideal for helping the patient return to normal blood glucose without inducing hyperglycemia• If the next meal is more than one hour away, this initial supplementation should be followed with a snack of mixed nutrients such as milk & cereal, or PB and crackers
  5. 5. Diabetic Management (cont) Blood glucose testing occurs 30 minutes prior to meal delivery While the timing may vary from unit to unit based on times that trays are received, it is important for staff to be aware of the time trays are delivered in their area and plan interventions accordingly In like manner, rapid-acting insulin doses should be administered within 15 minutes of the time the patient begins eating Basal insulin should be given at a consistent time, not necessarily with meals
  6. 6. Diabetic Management (cont)Accepting hyperglycemia• Due to fear of hypoglycemia, both nurses and patients often accept high blood glucoses rationalizing that “a little sweet is better than low”• While some apprehension is understandable, acknowledging the target range (70-130) and reinforcing this goal with patients will help deflate this false sense of security• Proper diet control and a consistent treatment plan are the real keys to success
  7. 7. Diabetic Management (cont)Education• A key piece of nursing is empowering our patients with knowledge that will help them improve their overall wellness• Our diabetes educator, as well as dieticians and pharmacy staff, serve as excellent resources and may help to relieve the concerns patients may experience while hospitalized• Also, the individual nurse is in a powerful position of influence as we walk our patients through the diabetic decisions they make daily

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