Diabetes Home Care Management

2. Providing consistency in day-to-day food intake (in type 1 diabetes)

3. Facilitating weight management (in type 2 diabetes)

5. As prescribed by the physician, the child may be instructed to follow the food exchange from the American Diabetic Association diet or the dietary guidelines for Americans (Food Guide Pyramid) issued by the U.S. Departments of Agriculture and Health and Human Services.

6. Dietary intake should include 3 meals per day, eaten at consistent intervals, plus a midafternoon carbohydrate snack and a bedtime snack high in protein (e.g. peanut butter sandwhich); consistent intake of carbohydrates at each meal and snack is needed.

7. Instruct the child and the parents that the child should carry candy with him or her at all times to treat hypoglycemia if it occurs.

8. Incorporate the diet into individual child’s needs, likes and dislikes, lifestyle, and cultural ad socioeconomic patterns.

10. 1 small box of raisins

11. 3 to 4 hard candies

12. Sugar cubes

13. Life savers

14. 1 candy bar

15. 1 tsp honey

17. 6 to 10 Life Savers or hard candy

18. 4 tsp of sugar

19. 4 sugar cubes

20. 1 Tbsp of honey or syrup

21. ½ cup of fruit juice or regular (nondiet) soft drink

22. 8 oz low-fat milk

23. 6 saltine crackers

25. fosters weight reduction and maintenance

26. increases insulin sensitivity /enhance action of insulin

27. Increases high-density lipoprotein (HDL) levels

28. Decreases triglyceride levels

29. Lowers blood pressure

30. Reduce stress and tension

33. History

34. Physical examination

35. Glycosylated hemoglobin (HbA1c ) assay

36. Exercise stress test

37. Foot evaluation

38. Laboratory determination of blood glucose level

39. Check the blood glucose levels before and after strenuous exercise:

40. Less than 100mg/dl = Client should eat 15 to 30 g of carbohydrate before exercise and should carry a carbohydrate snack as well as their diabetic medication.

41. 100 to 150mg/dl = Client may exercise and have a snack later.

42. Greater than 250 mg/dl and client has not just eaten = Ketone levels should be checked and wait to exercise, because vigorous activity can raise blood glucose levels by releasing stored glycogen.

43. Instruct client to plan exercises on a regular basis each day. Have the client plan an alternative activity in case environmental or other factors make the usual exercise difficult. Unplanned exercise can be dangerous for clients taking insulin or oral hypoglycemic agents.

44. Clients with diabetes must start any new activity at a well-tolerated intensity level and duration, with gradual (over a period of weeks or months) increases in intensity and duration until preset exercise goals are reached.

45. Clients should make sure they are adequately hydrated before starting exercise.

46. Encourage client to eat a 15 g carbohydrate snack (a fruit exchange) or a snack of complex carbohydrate with a protein before exercising to avoid hypoglycemia.

47. Advise client that prolonged strenuous exercise may require increased food at bedtime to avoid nocturnal hypoglycemia.

48. Instruct client to avoid exercise whenever blood glucose levels exceed 250 mg/dl and urine ketones are present.

49. Exercise should include warm-up and cool-down periods before and after the activity.

50. Counsel patient to inject insulin into the abdominal site on days when are or legs are exercised.

51. Avoid alcohol and beta blockers because they may increase the risk of hypoglycemia and hyperglycemia.

52. The primary effect of acute exercise is hypoglycemia (low glucose level), which is a significant risk for clients who exercise while taking insulin or oral hypoglemics. Adjustments are sometimes needed to prevent hypoglycemia in the client taking insulin, because hepatic glucose production is blocked or partially inhibited by exogenous insulin.

54. Encourage active participation of the client and family in the educational process.

55. Assess the client’s knowledge of diabetes mellitus and the use of oral hypoglycemic.

56. Teach the action, use and side effects of oral antidiabetic agents.

57. Remind that aspirin, alcohol, sulfonamides, oral contraceptives, and monoamine oxidase inhibitors increase the hypoglycemic effect, causing a decrease in blood glucose levels.

58. On the other hand, glucocorticoids, thiazide diuretics, and estrogen increase blood glucose levels.

59. Teach the client to recognize symptoms of hypoglycemia and hyperglycemia.

60. Teach the client to avoid over-the-counter medications unless prescribed by the physician.

61. Inform the client with type 2 diabetes mellitus that insulin may be needed during stress, surgery, or infection.

62. Teach the client about the importance of compliance with the prescribed medication.

64. Demonstrate and explain thoroughly the procedure for insulin self-injection.

65. Help client to master technique by taking a step-by-step approach.

66. Allow patient time to handle insulin and syringe to be familiar with the equipment.

67. Teach self-injection first to alleviate fear of pain from injection.

68. Instruct patient in filling syringe when he or she expresses confidence in self-injection procedure.

69. Review dosage and time of injections in relation to meals, activity, and bedtime based on client’s individualized insulin regimen.

71. Irritability/restlessness/shakiness

72. Disorientation

73. Nausea/vomiting

74. Diaphoresis/sweating/cool skin

75. Pallor

76. Weakness

78. Nausea/vomiting

79. Coma

80. Flushed, dry skin

81. Glucose and acetone in urine

82. Kaussmaul’s respiration

84. There is a relationship between hyperglycemia and diabetic retinopathy. It is extremely important to normalize blood glucose levels.

85. Hypertension can worsen diabetic retinopathy. Its diagnosis and aggressive treatment are important.

86. If the client has diabetic retinopathy, he should know that isometric exercises raise intraocular pressure and can aggravate proliferative retinopathy.

87. An ophthalmologist will be brought in to be part of the client’s diabetes management team. If you have any visual impairment, he can be referred to appropriate organizations for assistance.

88. If the client’s vision is blurred while reading, he may have hyperglycemia or macular edema. Floaters may indicate hemorrhage, and flashing lights may indicate retinal detachment. If the client experiences any of these occurrences, it should be reported.

90. Inspect feet daily and monitor feet for redness, swelling, or break in skin integrity.

91. Notify the physician if redness or a break in the skin occurs.

92. Avoid thermal injuries from hot water, heating pads, and baths.

93. Wash feet with warm (not hot) water and dry thoroughly (avoid foot soaks).

94. Do not soak feet.

95. Do not treat corns, blisters, or ingrown toenails.

96. Do not cross legs or wear tight garments that may constrict blood flow.

97. Apply moisturizing lotion to the feet but not between toes.

98. Prevent moisture from accumulating between the toes.

99. Wear lose socks and well-fitting (not tight) shoes, and instruct the client not to go barefoot.

100. Change into clean cotton socks daily.

101. Wear socks to keep feet warm.

102. Do not wear the same pair of shoes 2 days in a row.

103. Do not wear open-toed shoes or shoes with a strap that goes between the toes.

104. Check shoes for cracks or tears in the lining and for foreign objects before putting them on.

105. Break in new shoes gradually.

106. Cut toenails straight across and smooth nails with an emery board.

107. Do not smoke.