Glycemic Control IU Health Diabetes Centers

Transcription

1 Glycemic Control IU Health Diabetes Centers Central Nursing Orientation 3/10/2014 1

2 Objectives Identify laboratory results that diagnosis diabetes and reflect glycemic control Describe glycemic control agents Discuss dietary concerns for patients experiencing hyperglycemia or those with diabetes 3/10/2014 2

3 Hyperglycemia & Diabetes Hyperglycemia versus diabetes Are they the same? Can I have hyperglycemia without diagnosis of diabetes? Diabetes is a metabolic disorder The process in which the body breaks down and uses food for energy. 3/10/2014 3

4 Types of Diabetes Gestational Insulin resistance due to hormones during pregnancy 3-5% of pregnancies experience Gestational 35-60% chance of developing diabetes within 10 years of delivery 3/10/2014 4

5 Diagnosis of Diabetes A1C 6.5%. or FPG 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 hours or 2-h plasma glucose 200 mg/dl (11.1 mmol/l) during an OGTT or In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose 200 mg/dl (11.1 mmol/l) *In the absence of unequivocal hyperglycemia, criteria 1 3 should be confirmed by repeat testing. 3/10/2014 5

6 A1c & Blood Sugar Correlation Average Blood Glucose (mg/dl) % 7% 8% 9% 10% 11% 12% A1c% 3/10/2014 6

7 Blood Glucose Monitoring Possible blood glucose monitoring times: Before breakfast, lunch and dinner Bedtime Middle of the night (usually 3 am) 2 hours after meals Whenever hypoglycemia is suspected 15 minutes after a hypoglycemic event 3/10/2014 7

8 Targets Pediatric Population Daytime Bedtime 2-4 AM Under 2 years mg/dl mg/dl mg/dl 2-5 years mg/dl mg/dl mg/dl 6-12 years mg/dl mg/dl mg/dl 13 + years mg/dl mg/dl mg/dl 3/10/2014 8

9 Medications Sulfonylureas* Meglitinides Alpha-glucosidase Inhibitors Biguanides* Thiazolidinediones* DPP-IV Inhibitors* Incretin Mimetics Amylin Mimetics Insulins* 3/10/2014 9

10 Glucostabilizer Programs Basal/Bolus Therapy Basal (50% of total daily dose) Background, baseline Those with Type 1 ALWAYS need basal insulin ordered (even if they are experiencing hypoglycemia or are NPO) Bolus (50% of total daily dose three meals/day Meal dose and/or Correction dose Bolus dose is determined by: Premeal blood glucose Total carbohydrates eaten at the meal

11 Glucostabilizer Programs Insulin to Carbohydrate Ratio: ICR Units of insulin (Humalog) to cover for grams of carbohydrates eaten (examples below) 1:10 (1 unit of insulin for every 10 grams of carbohydrate) 1:15 (1 unit of insulin for every 15 grams of carbohydrate) Insulin Sensitivity Factor: ISF (correction dose) Blood glucose decrease for each unit of insulin (Humalog) given (examples below) 1:50 (1 unit decreases blood glucose 50 mg/dl) 1:30 (1 unit decreases blood glucose 30 mg/dl)

12 Hypoglycemia The IU Health Hypoglycemia Policy defines an episode as a blood glucose of 70mg/dL or less for the general population OR 60 mg/dl or less for pregnant women

13 What are Carbohydrates S S S S S

14 Carbohydrate Foods Nutrient body uses for energy Milk/Yogurt Fruit Starches Sweets 3/10/

15 Carbohydrate Counting Tools 3/10/

16 Carbohydrate Counting Tools 3/10/

17 Carbohydrate Counting Tools 3/10/

18 Carbohydrate Counting Tools Internet Pulse Page (Inpatient Glucose Management) Restaurant Websites Calorieking.com Applications (for smartphones and tablets) Lose It My Net Diary Go Meals 3/10/

19 Inpatient Diet Orders A patient may have a regular diet, diabetic diet, or a no concentrated sweets diet ordered. Foods containing carbohydrate are labeled on the carbohydrate modified menu for patient reference. A one carbohydrate serving equals 15 grams of total carbohydrate. There are some foods that contain less than 20 calories and 5 grams of carbohydrate and are considered free foods. 3/10/

20 Classic Cuisine The patient will determine when their meal is ordered; therefore, communication and education about medications that impact the meal is key. When a diet is ordered for a patient, an ambassador delivers a diet appropriate menu to the patient. Call Center Operators will remind patients to contact a nurse at the time the order is taken. The meal will arrive minutes after order is placed. The ambassador will remind the patient to notify the nurse when the meal is delivered. 3/10/

21 Carbohydrate Counting Insulin /Carbohydrate ratio must be ordered by a physician. Carbohydrates are calculated by the food that has been eaten. All carbohydrate sources are added together for a total amount of carbohydrates. 3/10/