Type ii diabetes mellitus

Disease Management and Brief Medication Overview

Adrienne G. Smith, Nursing Student, UNC-CH
A man buys a pet parrot and brings him home. But the parrot starts insulting him and gets really nasty, so the man picks up the parrot and tosses him into the freezer to teach him a lesson. He hears the bird squawking for a few minutes, but all of a sudden the parrot is quiet. The man opens the freezer door, the parrot walks out, looks up at him and says, "I apologize for offending you, and I humbly ask your forgiveness."The man says, "Well, thank you. I forgive you."The parrot then says, "If you don't mind my asking, what did the chicken do?" WHAT DO I NEED TO DO TO MANAGE THISDISEASE?  Go to regularly scheduled medical appointments  Blood sugar represents the level of glucose  Taking accurate and frequent blood sugar measurements is important for your overall health and treatment.  Food, or lack thereof, impacts your blood sugar  Drink, or lack thereof, impacts your blood sugar  Vitamins, herbs, and some supplements can impact  Sickness impacts your blood sugar levels.
 Stress impacts your blood sugar levels.
 Blood sugar levels naturally fluctuate throughout the day in response to the needs of the body’s metabolism.  Normal Blood Sugar Levels (Palmer, 2010)…  2 hour post-prandial (after meal): <140  According to the American Diabetes Association (2010), Diabetics maintaining tight glycemic control should be able to achieve a blood sugar level between 70 and 130 before meals and less than 180 two hours after meals.
 If you’re experiencing a major illness, your goals may be adjusted until you are considered medically stable.
 Before you take your blood sugar, always remember to wash your hands thoroughly with soap. I recommend also wiping the skin with an alcohol swab.
 Prepare your glucometer and insert your test strip.
 To make sampling easier, the American Diabetes Association recommends that you rub/gently massage the area that you plan on testing (2010).  A common testing site is the finger. You may find the wringing your hands is an effective way to warm the fingertips and increase circulation prior to pricking.
 Take a new lancet and place it firmly against the skin. If testing fingers, try sampling from the side of the finger tip. Engage.
 If you find that your blood isn’t forming an adequate sample size, gently perform a milking motion to enhance blood flow.
 Put the edge of the testing strip to the blood drop  If your glucometer takes in an adequate sample, you should receive a result within a few moments.
 Record the time, date, and blood sugar level for your physician. Some glucometers are designed to record this information automatically.
 The Hemoglobin A1C test is a blood test performed by your health care provider to find your 3 month blood sugar level estimate. This allows your health care provider to have a clearer picture of how well your blood sugar levels have been controlled (Medicine Net, 2009).
Mean Blood Sugar
 Goals for people with diabetes (Palmer, 2010)  A1c <7% and blood glucoses close to normal without causing adverse reactions (average ~ 150)  At home ketone tests, purchased from the local pharmacy, examine the urine for the presence of ketones.  “Ketones are substances that are made when the body breaks down fat for energy. Normally, your body gets the energy it needs from carbohydrates in your diet. But stored fat is broken down and ketones are made if your diet does not contain enough carbohydrate to supply the body with sugar (glucose) for energy or if your body cannot use blood sugar (glucose) properly” (WebMD, 2009).
 According to the American Diabetes Association (2010), you should test for ketones if…  Your blood glucose is more than 300 mg/dl  You feel nauseated, are vomiting, or have abdominal  You are sick (for example, with a cold or flu)  You are thirsty or have a very dry mouth  You have a hard time breathing Your breath smells  You feel confused or "in a fog"  If your testing strip indicates small amounts of ketones, retest your urine within the next 4-5 hours to monitor for changes.
 If your testing strip indicates moderate to large amounts of ketones, call your physician immediately.  The presence of ketones in urine is indicative that your diabetes is uncontrolled. Prolonged exposure to ketones within the blood can be toxic to the body (American Diabetes Association, 2010).
 If you’re taking insulin or any other injectable
medication, you should be seeing your doctor
every 3-4 months to ensure that you are receiving
adequate medication (Medicine Net, 2005).
 If you’re taking oral medication, you should visit
with your physician every 4-6 months (Medicine
Net, 2005).
 Be sure to bring a record of your blood glucose home  Write down any concerns you may have before going to the doctor so that you don’t forget them.
 See your dentist for a cleaning and check-up every 6 months. Diabetes can increase your risk for oral health concerns, such as gum disease and loose teeth (American Diabetes Association, 2010).
 See your eye doctor once a year or more often if you experience a change in vision. During these exams, your physician should perform a dilation to examine the inside of your eyes.
 See your podiatrist annually and participate in the Fearrington Cares Foot Clinic to stay on top of protecting your feet.
 Rethink how you approach eating and exercise.
 Talk to your health care provider about what you can be doing better in your personal life.
 Set goals—give yourself a direction to go…whether that’s having more good days than bad, taking a trip somewhere special, or taking up a new hobby.
 Your blood sugar level is related to more than what you eat. Nourish your mind and your body.
An old man decided his old wife was getting hard of hearing. So he called her doctor to make an appointment to have her hearing checked. The doctor said he could see her in two weeks, and meanwhile there's a simple, informal test the husband could do to give the doctor some idea of the dimensions of the problem.
"Here's what you do. Start about 40 feet away from her, and speak in a normal conversational tone and see if she hears you. If not, go to 30 feet, then 20 feet, and so on until you get a response." So that evening she's in the kitchen cooking dinner, and he's in the living room, and he says to himself, "I'm about 40 feet away, let's see what happens.""Honey, what's for supper?" No response.
So he moves to the other end of the room, about 30 feet away. "Honey, what's for supper?" No response.
So he moves into the dining room, about 20 feet away. "Honey, what's for supper?" No response.
On to the kitchen door, only 10 feet away. "Honey, what's for supper?" No response.
So he walks right up behind her. "Honey, what's for  There are 6 classifications of oral hypoglycemic medication available at present to treatment Diabetes Type II (American Diabetes Association, 2010):  Sulfonylureas stimulate the beta cells of the  Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (Diabinese) is the only first-generation sulfonylurea still in use today  There are three second-generation drugs: glyburide (Micronase, Glynase, and Diabeta)  These drugs are generally taken one to two times a day,  Action: Promote insulin secretion from the pancreas  Target Population: Patients with type 2 diabetes who have the ability to secrete insulin
 Side Effects: Weight Gain, Hypoglycemia, interaction with alcohol (flushing, nausea, vomiting)  Those taking this medication should…  Meglitinides are drugs that also stimulate the beta cells to release insulin. They are taken before each meal, three times daily (American Diabetes Association, 2010).
 This is a great drug class for people who eat inconsistently because of the short onset time of the medication (Palmer, 2010).
 This medication should be taken 30 minutes prior to eating and should be skipped if a meal is missed (Palmer, 2010).
 “Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver” (American Diabetes Assoc, 2010).  Example of Biguanide: Metformin (Glucophage)  “Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day” (American Diabetes Assoc, 2010).  A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food (American Diabetes Assoc, 2010).
 “These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver” (American Diabetes Assoc, 2010).  “This class of medications requires monitoring of liver function due to adverse effects reported in an earlier generation of the current drugs on the market” (American Diabetes Assoc, 2010).  “Both drugs appear to increase the risk for heart failure in some individuals, and there is debate about whether Avandia may contribute to an increased risk for heart attacks” (American Diabetes Assoc, 2010).
 “Both drugs are effective at reducing A1C and generally have few side effects” (American Diabetes Assoc, 2010).
 “These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar” (American Diabetes Assoc, 2010).  “Their action slows the rise in blood glucose levels after a meal” (American Diabetes Assoc, 2010).  “They should be taken with the first bite of a meal”  “These drugs may have side effects, including gas and diarrhea” (American Diabetes Assoc, 2010).
 “They work by preventing the breakdown of a naturally occurring compound in the body, GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself. By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated” (American Diabetes Assoc, 2010).  DPP-4 Inhibitors help improve A1C without causing  “DPP-4 inhibitors do not tend to cause weight gain and tend to have a neutral or positive effect on cholesterol levels” (American Diabetes Assoc, 2010).  Patients not meeting blood sugar goals with oral agents or with contraindications to oral agents (Palmer 2010).
 It mimics natural insulin to reduce blood sugars  Rapid and short-acting insulins can be used to target post-prandial (after dinner) glucose levels  Intermediate and long-acting insulins can be used to target between meals and fasting glucose levels  Side Effects: Weight gain, hypoglycemia  Important things to consider when following an  Always stay on top of your blood sugar testing. Your doctor will have recommendations of when you should test based upon medication administration and eating.
 Keep your insulin in a safe location. I recommend storing it in the refrigerator to protect against breakdown of the formulary.  Before preparing any injections, wipe the top of your  Always use a fresh syringe and needle.
 Be aware of how your insulin looks and monitor for  When traveling via the airport, you may find it necessary to carry a paper copy of your prescription so that you can carry on your insulin supplies. Be prepared ahead of time.
 If you miss a dose, check in with your physician for WHAT SHOULD YOU PREPARE IN CASE OF ANEMERGENCY?  Always carry an updated list of your medications in your wallet or on your person, along with the phone number of an emergency contact.
 If you know that you’re going to be away from home for a while, be sure to pack a sustaining snack. Travel size packets of peanuts are great!  Carry your glucometer with you in case you begin to feel poorly while away from home.
 Always keep at least 3 days worth of diabetic medications, food, and water supplies at your home in case a natural disaster (e.g. hurricane, tornado, etc) occurs. American Diabetes Association. (2010). Checking your blood glucose. Retrieved from American Diabetes Association . (2010). Checking for ketones. Retrieved from American Diabetes Association, . (2010). Diabetic medications. Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/what-are-my-options.html American Diabetes Association. (2010).Living with diabetes. Retrieved from American Diabetes Association. (2010). Oral health care. Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/diabetes-and-oral.html MedicineNet. (2009). Hemoglobin a1c testing. Retrieved from MedicineNet. (2005). Diabetes: working with your health care team. Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=42240&page=2#often Palmer, C. (2010). Pharmacology for the management of diabetes. Informally published manuscript, UNC-H, UNC-Chapel Hill, Chapel Hill, NC.
WebMD . (2009). Ketones. Retrieved from http://diabetes.webmd.com/ketones-14241

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