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diabetes
Medicine, diabetes is a group of metabolic diseases characterized by chronic hyperglycemia caused by the combined effect of genetic and environmental factors. It is very detailed. Welcome to like and collect it~
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diabetes
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- Outline
diabetes
Definition: A group of metabolic diseases characterized by chronic hyperglycemia caused by a combination of genetic and environmental factors
Classification
Type I (insulin-dependent): most common in children and adolescents, with decreased plasma insulin levels
Type II (insulin-resistant type): more common in adults, plasma islet cell antibodies are positive
Clinical symptoms
metabolic disorder syndrome
Polydipsia, polyphagia, polyuria, weight loss
Itchy skin
complication
acute
Diabetic ketoacidosis (DKA): common in type I
Main manifestations include hyperglycemia, ketosis, acidosis, severe dehydration, and rotten apple smell.
Fluid replacement is the first and key measure to rescue DKA. The basic principle of infusion is "fast first, then slow to produce salt and then sugar". The amount and speed of fluid replenishment depend on the degree of water loss. Encourage patients to drink water, use low-dose insulin, and correct electrolyte and acid-base balance
care
Avoid triggers: Prevent various infections, develop regular eating and daily living habits; take medication as prescribed by the doctor, do not reduce the amount of insulin or stop insulin at will. In case of stroke, myocardial infarction, trauma, surgery, pregnancy, and childbirth, insulin treatment should be given promptly. When vomiting or abdominal distension occurs, ensure adequate fluid intake.
Condition monitoring: Closely observe and record the patient's vital signs, consciousness, and 24-hour input and output, and evaluate skin elasticity and mucous membrane dryness. Spend. Regularly monitor changes in blood sugar, blood ketones or urinary ketones, blood electrolytes, and osmotic pressure.
First aid cooperation and care: Immediately establish two intravenous channels, quickly replenish fluids, inject low-dose insulin intravenously, closely observe the efficacy and adverse reactions, and adjust the insulin administration speed in a timely manner according to the blood sugar value. Absolute bed rest, keep warm, continue low-flow oxygen inhalation, and strengthen daily care, especially skin and oral care.
Hyperosmolar hyperglycemic syndrome (HHS): common in type II
Severe hyperglycemia, high plasma osmolarity, dehydration, and most severe, neurological symptoms
Same as above, for severe dehydration, intravenous fluid rehydration and nasal feeding are given.
Hypoglycemia: <2.8mmol/L, sympathetic nerve excitement and central nervous system excitement
Sugar supplement
care
Strengthen prevention, monitor blood sugar, and deal with hypoglycemia promptly if found
① When first using various hypoglycemic drugs, start with a small dose and gradually adjust the drug dose according to the blood sugar level.
② Eat meals regularly and quantitatively. If the amount of meals is reduced, the dose of hypoglycemic drugs will be reduced accordingly; patients who are prone to hypoglycemia in the latter half of the night and early in the morning should increase their staple food for dinner.
Ethanol can directly cause hypoglycemia, so limit ethanol intake and avoid drinking on an empty stomach.
④ Arrange the amount of exercise reasonably. When the amount of exercise increases, reduce the dosage of insulin and add meals in time.
⑤ Intensive treatment should monitor and record blood sugar so that the dosage of insulin or hypoglycemic drugs can be adjusted in a timely manner.
⑥Once hypoglycemia is confirmed, for those with clear consciousness, take 15 to 20 g of carbohydrate food (glucose is preferred) orally; for those with impaired consciousness, give 20 to 40 ml of 50% glucose solution intravenously until hypoglycemia is corrected.
Chronic
Macrovascular disease (the most severe and prominent): heart, brain, peripheral blood vessels
Small vessel disease: retinal and renal disease
Neuropathy: Peripheral nerves are the most common, distal symmetrical polyneuropathy, numbness, burning, pins and needles sensation, and cotton feeling.
Diabetic foot: itching, ulceration
care
① Check both feet once a day to see if there is any loss of sensation, numbness, or tingling in the feet; check whether the skin of the feet has any color, temperature changes, and pulsation of the arteries in the feet; observe whether there is paronychia, athlete's foot, blisters, Ulcers, necrosis, etc.
② Wash your feet once a day with water temperature of 37-40℃; dry them with a soft light-colored dry towel after washing, especially between the toes. If the skin of the feet is dry, you can use oil-based skin care products, and it is not suitable to rub it between the toes; Toenail trimming should be done after washing your feet. Trim your nails flush with your toes and round off the sharp edges. Avoid trimming your nails or treating your nails or toenails with chemicals.
③ It is not advisable to use hot water bottles, electric heaters and other items to directly keep feet warm in winter to avoid burns; avoid walking barefoot in summer and do not wear slippers when going out.
④ Before wearing shoes, check whether there are any foreign objects in the shoes and whether the lining is flat; half an hour after trying on the new shoes, check whether the feet are squeezed or rubbed, and then gradually increase the time of wearing shoes; do not wear them tight or have burrs Socks or shoes; choose light-colored socks with good water absorption and breathability. Socks should be changed and washed every day.
⑤ Instruct and assist patients to use various methods to promote blood circulation in limbs, such as walking and leg exercises, and avoid sitting cross-legged or crossing their legs. Instruct patients to seek medical attention as soon as possible if the wound or local skin has congestion, redness, swelling, or fever.
Auxiliary inspection
urine sugar
Blood sugar: the main basis for diagnosis and the main indicator for detecting disease conditions and treatment effects.
Glucose tolerance test: Glucose tolerance test: For those whose blood sugar is higher than the normal range but does not meet the diagnostic criteria for diabetes, a glucose tolerance test must be performed, including oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT). Oral glucose tolerance test (IVGTT) is often used in clinical practice. Glucose Tolerance Test "Test Method: 0GTT should be performed in the early morning, fasting for 8-10 hours. The amount of carbohydrates eaten in the 3 days before the test should not be less than 150g/d, and there should be no nausea, vomiting, or fever during the illness: after taking venous blood on an empty stomach in the morning of the test, dissolve 75g anhydrous glucose powder in 250~300m of drinking water, 5 Drink it within minutes, start timing from the first sip of sugar, and take intravenous blood at 30, 60, 120, and 180 minutes after taking sugar. During the entire trial, eating, smoking, and physical exertion are prohibited.
Pancreatic islet p cell function test
Glycated hemoglobin (GHbA1): one of the disease monitoring indicators
Diagnostic points:
Nursing measures
Rest and activities
①Those with acute complications of diabetes, obvious hypoglycemia, and severe chronic complications of various heart, kidney, and other organs should rest in bed.
②Those whose condition is stable should choose appropriate exercises, such as walking, brisk walking, jogging, climbing stairs, riding a bicycle, playing badminton, swimming, etc.
③The best time to exercise is 1 hour after a meal, and the amount of exercise is at least 150 minutes a week, 30 to 40 minutes each time.
④ Exercise intensity is when the patient's heart rate reaches 60% of the individual's maximum oxygen consumption (heart rate = 170 - age).
Diet care
The dietary principles are to control total calories, eat regularly and quantitatively, add reasonable snacks, strictly limit various sweets, eat more light foods high in fiber, and avoid drinking alcohol. Patients with diabetic nephropathy should be given a high-quality, low-protein diet. Less than 6 grams of salt per serving
Calculate total calories: Calculate total calories based on the patient’s gender, age, ideal weight [ideal weight (kg) = height (cm)-105], nature of work, living habits, etc. Children, pregnant women, wet nurses, those who are malnourished or emaciated, and those with wasting diseases may add 5 kcal per kilogram of body weight per day as appropriate, and those who are obese may reduce 5 kcal as appropriate. The total calories required per kilogram of ideal body weight for adults per day are shown in Table 75-5. Table 7-5-5 Total calories required per kilogram of ideal body weight per day for adults (unit: kcal/kg) resting state light manual labor 25~30 30~35 moderate physical labor 35~40 Heavy physical labor >40
Food composition: The general principle is a diet high in carbohydrates, low in fat, moderate in protein and high in fiber. Among them, carbohydrates account for 50% to 60%, fat does not exceed 30%, and protein accounts for 10% to 15%.
Distribution of staple food: According to the patient's living habits, condition and drug treatment arrangements, develop the habit of regular and quantitative meals. Three meals are divided into 1/5, 2/5, and 2/5 into 1/3, 1/3, and 1/3, and meals are divided into 1/7, 2/7, 2/7, 2/7, and 2 /7.
Other precautions: Overweight people should avoid eating fried foods, eat less animal offal, crab roe, fish roe and other high-cholesterol foods; quit smoking and limit alcohol consumption, and limit all kinds of sweets, such as candies, desserts, biscuits and various sugary drinks; restrictions Salt intake, <6g per day.
Condition observation
Monitor blood sugar, blood lipids, blood pressure, and weight. Observe the efficacy of lifestyle intervention and antidiabetic drugs. Control blood sugar, blood lipids, blood pressure, and weight within ideal ranges to reduce the risk of diabetes complications.
Monitor hypoglycemic reactions and observe whether patients have symptoms of hypoglycemia such as palpitation, sweating, hand shaking, hunger, blurred vision, etc., especially those taking insulin secretagogues and insulin injections. Elderly patients often have no obvious symptoms of hypoglycemia due to autonomic nervous system dysfunction and require intensive blood glucose monitoring.
Medication
Insulin treatment
(2) Storage: Unopened insulin is stored in the refrigerator at 2~8°C. After opening, the insulin can be used at room temperature for 28 days. It is not recommended to store insulin in the refrigerator because the insulin product is more stable at room temperature and is easier to mix. Evenly, the injection is more comfortable; insulin must not be frozen. If the insulin is found to be frozen, it cannot be used; avoid overcooling, overheating, direct sunlight, violent shaking, etc., otherwise the protein will coagulate and denature and become ineffective. Prohibited.
Injection method
Including intravenous injection and subcutaneous injection. Suitable sites for subcutaneous injection are the deltoid muscle of the upper arm, gluteus maximus, front thigh, abdomen, etc. Insulin is absorbed fastest in the abdomen, followed by the upper arms, thighs, and buttocks.
② Injection sites should be rotated frequently. Long-term injection of the same site may cause local subcutaneous fat atrophy or hyperplasia and local induration. "Major rotation" should be carried out on the abdomen, upper arms, outer thighs and buttocks; when injecting in the same area, "small rotation" should also be carried out, that is, at least 1cm away from each injection point to avoid injecting in areas with scars or induration . If induration occurs, apply heat but avoid burns
③ The special insulin syringe needs to pinch the skin at 45° or 90° to insert the needle; the 8mm insulin needle needs to pinch the skin to insert the needle vertically; the 4mm, 5mm and 6mm insulin needles can be inserted vertically, and generally there is no need to pinch the skin. For thin people, especially children, 5mm and 6mm insulin needles are used, and the skin needs to be pinched to form a skinfold before injecting. When the inner stopper of the syringe is pushed into place, the syringe needle can be pulled out without staying under the skin.
④ When using an insulin injection pen, pay attention to the matching of the pen and the refill. Before each injection, confirm whether there is a sufficient dose in the pen and whether the medicine solution has deteriorated. After fully pressing the button with your thumb, you should wait for at least 10 seconds before pulling out the needle to ensure that all the drug dose is injected into the body. Remove the needle immediately after pulling out the needle.
Others: Before using intermediate-acting and premixed insulin, roll the insulin horizontally and flip it up and down more than 10 times each to fully mix the liquid in the bottle until the insulin becomes a uniform white suspension.
Used insulin needles and insulin syringes should be discarded in a special sharps basin.
When using a leg insulin pump, replace the drug reservoir, special catheter and injection site every 4 to 7 days to avoid needle clogging and local infection, and place the insulin pump in a safe and convenient location for the patient.
Patients who inject insulin generally monitor their blood sugar 2 to 4 times a day. If blood sugar fluctuates excessively or hyperglycemia persists,