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Medicine Chapter 7 Endocrinology Section 7 Diabetes 2
This is a mind map about Chapter 7 Endocrinology of Medicine, Section 7 Diabetes 2, with a detailed introduction and comprehensive description. I hope it can help those who are interested in learning.
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Medicine Chapter 7 Endocrinology Section 7 Diabetes 2
- bacteria
This is a mind map about bacteria, and its main contents include: overview, morphology, types, structure, reproduction, distribution, application, and expansion. The summary is comprehensive and meticulous, suitable as review materials.
- Plant asexual reproduction
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- Reproductive development of animals
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- Outline
Section 7 Diabetes
medical treatement
Oral hypoglycemic drugs
Insulin treatment
Dawn phenomenon - good blood sugar control at night, high blood sugar due to bleeding within a short period of time at dawn - increase the amount of insulin before going to bed
Somogyi reaction - nocturnal hypoglycemia is not found, bleeding rebound hyperglycemia - reduce the amount of insulin before going to bed or add an appropriate meal before going to bed or change the insulin dosage form
Bariatric surgery treatment
Pancreas and islet cell transplantation
Treatment of acute complications of diabetes
Diabetic ketoacidosis treatment
Rehydration—Infusion is the first and key measure to rescue diabetic ketoacidosis
low dose insulin therapy
Correct electrolyte and acid-base balance imbalance
Insulin therapy should not be started until serum potassium rises to 3.5
If the urine output per hour is more than 40ml and the blood potassium is less than 5.2, intravenous potassium supplementation can be used
Treatment of hyperosmolar hyperglycemic syndrome
When blood sugar drops to 16.7, 5% glucose solution can be used to add short-acting insulin to control blood sugar.
Treatment of lactic acidosis: water and electrolyte balance. Dialysis if necessary.
Hypoglycemia
clear consciousness
Oral carbohydrate foods (glucose is best) - monitor blood sugar every 15 minutes
≤3.9: Oral glucose or intravenous injection
3.9 or above: more than 1 hour before next meal, starch or protein food
≤3, 50% glucose 60ml intravenous injection
Disorder of consciousness - intravenous injection of 20-40ml of 50% glucose solution, or intramuscular injection of glucagon 0.5-1mg
Test blood sugar every 15 minutes
Same as above.
Uncorrected hypoglycemia - intravenous injection of 5% or 10% glucose, or addition of glucocorticoids
Treatment of gestational diabetes
Avoid taking oral hypoglycemic drugs
Early vomiting can easily lead to hypoglycemia
In the middle and late stages, the secretion of insulin antagonistic hormone (prolactin) increases - diabetic ketoacidosis. After delivery, the antagonistic factor is small and can easily lead to hypoglycemia.
Fetuses are prone to malformations, macrosomia, growth retardation, and neonatal hypoglycemia.
Perioperative management of diabetic patients
Blood sugar level: Fasting 7.8 or less, postprandial 10 or less
Oral hypoglycemic drugs
Discontinue it the night before and on the day of minor surgery, and switch to insulin therapy
Major surgery. Stop taking oral hypoglycemic drugs 3 days before surgery.
Nursing measures and basis
Malnutrition: below or above body requirements
(Requires knowledge of formulation) ⭐ Diet care
Formulate total calories (per kg of ideal weight. Ideal weight = height cm-105)
Rest: 25-30
Light physical strength: 30-35
Moderate physical strength: 35-40
Severity: 40
Children who are suffering from malnutrition, emaciation, and wasting diseases: add 5 kcal per kilogram.
Obesity, reduce by 5 per kilogram to gradually return to ideal weight ±5%
Composition and distribution of food (selected, simplified)
food composition
High carbohydrate, low fat, moderate protein, high fiber
Carbohydrates account for 50-60% of total calories
Fat: less than 30% and no more than 7% saturated
protein
Normal kidney function: 10-15% high-quality protein accounts for at least half
With overt proteinuria: 0.8g per kilogram of ideal body weight per day. But starting from the decline in glomerular filtration rate, protein is 0.6g per kilogram per day.
Distribution of staple food: regular and quantitative, 1/3 each. . Patients taking insulin injections or oral hypoglycemic drugs and whose condition fluctuates - 5-6 meals a day. Take 25-50g of staple food from three main meals for snacks
Quit smoking and limit drinking, no more than 2 times a week, 15g/d for women, 25g/d for men, vegetable oil for cooking, eat less high cholesterol, salt <6g. Strictly limit sweets, measure your weight once a week
Sports Care: Aerobic Exercise
Exercise time: 1 hour after a meal (optimal), starting from the first bite, at least 150 minutes a week, 30-40 minutes each time
Amount of exercise: heart rate = 170 - age.
Oral medication care
Sulfonamides
Glibenclamide - Take half an hour before meals - Watch for hypoglycemic reactions. For newly diagnosed type 2 diabetes patients (diet and exercise control is ineffective)
Biguanides - taken with or after meals, starting with small doses - reduce gastrointestinal adverse effects
Alpha-glucosidase inhibitor - acarbose - chew with the first bite of starchy food
Insulin care
Injection: intravenous injection, subcutaneous injection
Storage: unopened - refrigerate at 2-8°C. In use - It can be used for 28-30 days at room temperature. Avoid violent shaking.
First draw quick-acting, then draw medium-long-acting, mix and inject
Injection point: large rotation site, small rotation distance more than 1cm
Monitor blood sugar: 2-4 times a day
Prevent infection: Strictly sterile, disposable needles.
adverse reactions to insulin
Hypoglycemic reaction - the most serious, so you need to eat in time after taking insulin.
Risk of infection
Disease monitoring
Prevent upper respiratory tract infections
Prevent urinary tract infections: Wash the vulva frequently with warm water and dry it. Urinary retention and prompt urination
Skin care: bathing water temperature, neutral soap, clothing, do not scratch
Potential complications: Diabetic foot (short answer, only larger answers)
Assessing patients for risky diets for foot ulcers
Foot observation and examination: once a day
Keep feet clean: wash once a day, no more than 10 minutes, water temperature 37-40, apply ointment if necessary
Prevent trauma: wear new shoes for 20-30 minutes for the first time
Promote blood circulation in limbs
Actively control blood sugar and persuade patients to quit smoking
Potential complications: ketoacidosis, hyperosmolar hyperglycemic syndrome
Potential complications: hypoglycemia
⭐How to prevent hypoglycemia
① Understand the medication and do not change the medication and dosage at will
②Increase activity level, reduce insulin dosage and add meals in time
③ Hypotension is easy to occur in the early morning or in the middle of the night. For dinner, increase the amount of staple food or food with high protein content.
④Eat a meal promptly after injecting rapid-acting or short-acting insulin. Those who are seriously ill should eat first before taking the injection.
⑤ When taking antidiabetic drugs for the first time, start with a small dose and gradually adjust the drug dose according to the blood sugar level.