Diabetic Management Plan

Diabetes Mellitus is a disease effn to man since the ancient times. Hieroglyphics of Egypt, which dated back in 1500 BC, illustrated symptoms of diabetes. During this time, people depicted diabetes to be char deeder 2 only and quality 1 diabetes is a newly discovered disease. However, this has been do clear by researches and studies that reference 2 diabetes is different from eccentric 1 diabetes (Hanas 2007). In the open, cases of diabetes continuously rise especially cases of type 1 diabetes.Type 1 diabetes is an insulin dependent diabetes that is universal to children and teen developrs. Here, the clay enumerately does not score insulin rendering the glucose routine little for an individual (Fox and Kilvert 2007). The glucose go through on the store rises and affects certain body functions making the individual seek checkup attention. Diabetes has no cure. When matchless has diabetes, he or she has it for lifetime. However, certain ways in managing diabetes, whet her it is type 1 or type 2, ar found but with consideration to medication, action mechanism, and diet.Strict chemical bond to medication regimen is useful in hampering the ontogeny of diabetic complications. Regular come upon for or physical activity as well as befitting eating habits is in addition proven to attend let down melodic phrase peag directs making it controllable. In addition, sponsor supervise of affinity glucose pull up stakes al minuscule an individual to anticipate and act in response to the previously await glucose take aim. The Case of Jodie Jodie is a 17-year- senescent girl who has in put together(p) been diagnosed with type 1 diabetes fol scummying portal to the local Emergency De disjointment in DKA.She is currently studying year 12 at broad(prenominal) school, plays netball every Satur twenty-four hours afternoon and enjoys going to parties with her friends. Jodie weighs 55kg with a BMI of 20. She lives happily at headquarters with her pargonnts and older br separate. Jodie has been commenced on a basal bolus insulin regimen using Humalog and Levemir. nutritional Management Managing diet is to a fault a key factor in proper focusing of diabetes. It is classic to emphasize to the leaf node and the family that the leaf node is not winning a diabetic diet but quite a a balanced repast.Emphasis moldiness in like manner be considered on the ethnicity of the client as well as cultural and apparitional background of the enduring. Before winning these into considerations, it is pregnant to know the basic thermic uptake of the client. By multiplying the pack of the Jodie in pounds (121 lbs) to 10 (constant multiplier for female), you al get downning base for come up with a total of 1210. This is the basic caloric get of Jodie. Multiplying the basic caloric acquire (1210) with 0. 40 (constant multiplier for rigorous activity) lead come up with a resulting activity based caloric take (605).Calories for digestion faecal matter in like manner be calculated by multiplying the sum of basic caloric pulmonary tuberculosis and activity based caloric needfully (1210 + 605) to 0. 10 (constant number). The result would be 181. 5. Lastly, calculate for the total daily caloric phthisis by summing up the basic caloric inhalant, activity based caloric intake, and calories essential for digestion (1210 + 605 + 181. 5). The result would be 1996. 5. This is the caloric needs of Jodie every Saturday since she is engaged in netball and partying with her friends. On the other hand, the caloric intake of Jodie from Monday to Friday and sunshine would be 1863. 4.Upon computing the daily caloric intake of Jodie, it sewer be think that energy needs varies among individuals on a daily basis, and depends greatly on the age, gender, and ethnicity (How to por feed Your Total Daily Calorie necessitate 2010). Smart, Aslander-van Vliet and Waldron (2009) proposed how total caloric intake mol diness(prenominal)iness be distributed Carbohydrates must constitute intimately 50-55% fats must be 30-35% protein must be 10-15% and sucrose must be 10%.T herefore, Jodie must aim a bread intake of 931. 7-1024. 87 calories (M-F, Sun) and 998. 25-1098. 08 calories(Sat) fat intake of 559. 02-654. 19 calories (M-F, Sun) and 598. 5-698. 78 calories (Sat) protein intake of 186. 34-279. 51 calories (M-F, Sun) and 199. 65-299. 48 calories (Sat) and sucrose intake of 186. 34 (M-F, Sun) and 199. 65 (Sat). When victorious carbohydrate voluminous food, it might be necessary to entangle goodish sources like vegetables, fruits, legumes, whole grains, and depression fat milk. defecate into consideration other alternatives for the source of food by consulting the carbohydrate exchange table, cabohydrate counting and the use of glycemic point and exponent. In the consumption of fat, food with hard fat must be special to less than seven percent of total caloric intake.Every week, ii or more(prenominal) servings of fish is permissible but with license to the commercially produced fish fillet (Ameri green goddess Diabetes necktie 2007). Replace saturated fats with monounsaturated fatty acids and unsaturated fatty acids through the use of low fat dairy products, lean meats, chromatic and sesame seed oil, sunflower oil, maize oil, and soybean oil. Encourage intake of protein from vegetables (legumes) and animals (lean meat, fish, low dairy products) because it promotes growth and is a acceptable source of nitrogen for the body. Take alike into consideration that the coarseness intake of the client must be less than 6 grams per day.Advise t water individuals who prepare the food that they should evacuate adding salt in cooking and in meals. In addition, excessive intoxi chiffoniert should be avoided because it intermeddles with gluc geniusogenesis resulting to elongated hypoglycaemia. The diligent must overly be advised to wear identifications about her diabetes, and birth carbohydrates onwards, during, and after drinking. Drinking, on the other hand, must be through in rilievo and must consume drinks with clipd alcohol content. Prevent nocturnal hypoglycemia by consuming carbohydrate-rich bedtime snack.Blood glucose overseeing must be dvirtuoso more often at night until tiffintime of the following day (Smart 2009). Monitoring Patients with Diabetes Knowing that diabetes can hand to some serious complications, it is better if one should know the things that he/she should monitor in govern to close out these complications. One should have vigilant monitoring of lineage sugar. scientific evidence shows that tightly controlling bank line sugar levels can prevent the development and progression of small declination vas (microvascular) disease and nerve disease (neuropathy) (Wendt 2009).Since eminent blood sugar is considered as the culprit to most of the diabetic complications, monitoring blood glucose by the forbe aring is extremely important to prevent consequences from unmonitored blood glucose. Low glucose level whitethorn lead to hypoglycemia. Mild hypoglycemia can cause a psyche to tincture uncomfortable and can interfere with his normal functioning. However, severe hypoglycemia can cause seizure, loss of consciousness, and coma (Kelly 2006). Avoiding risques and lows in blood sugar entrust not only make the unhurried feel better, but provide significantly reduce his/her adventure of diabetes complications.Cholesterol levels should to a fault be monitored. A test done to monitor the cholesterol level of a diabetic soul is called fasting lipid profile. It is a blood test that measures the total cholesterol, HDL and low-density lipoprotein cholesterol levels, and triglyceride levels in the bloodstream. It is also utilize to assess the risk for the development of coronary thrombosis artery disease, one of the predisposing factors for oculus clap (Kaufman 2010). Knowing that cholesterol affects the blood vessels of the retina and the heart gives the health provider a cue that some(prenominal) significant summation in the level would necessitate immediate monitoring and intervention.If cholesterol is controlled, the risk of developing complications is greatly reduced. Keeping track of blood blackjack is important because people who have diabetes tend to have more trouble with high blood pressure than people who do not have the disease. Having both diabetes and high blood pressure can pack a damaging one-two punch as far as increase the risk of heart disease, stroke, and shopping mall, kidney and nerve complications (Manzella 2006). Elevated blood pressure increases blood flow into the heart and soul, accelerating diabetic retinopathy (Chous 2006). Knowing the early signs and symptoms are also key in preventing diabetic complications.However, diabetic retinopathy has no early signs and symptoms. Jodie then must be aware of the yearly eye examination that must be done after the preliminary examination inwardly 5 years after the diagnosis of diabetes (Diabetes 2010). Dilated eye examination must be done every year by an optometrist or ophthalmologist versed about and experienced with diabetes and diabetic eye disease (Chous 2006) in order to know the extent of eye affectation. Both the persevering and the health provider should also monitor some signs and symptoms to prevent blindness. Any resuscitate with regard to the tolerants vision must be taken seriously.Be aware if the patient complains of hang dark spots that interferes with his/her vision. It may propose blood leak to the vitreous humor, which can lead to blindness. Also, take into consideration the increasing difficulty in performing things that require focus such as meter interlingual rendition and sewing. Amputations can also be prevented if the patient has vigilant foot business organization. Foot deal out is important since the patient with diabetes has decreased maven on the lower extremities. Preventive measures would take on watching for signs and symptoms of impending ulceration.The patient and the health provider should be aware of any swelling, thick hard skin or corns, and any blisters or breaks on the skin. Take good palm of small cuts and abrasions immediately. When choosing shoes, make sure that they fit well and forego the toes to move freely. Another complication of type 1 diabetes is diabetic ketoacidosis, the reason why Jodie was rushed to the emergency department. The goal for the management of DKA is the chastening of fluid and electrolyte imbalances, restoration of spread blood volume to normal, and identification and correction of factors that contributes to the development of diabetic ketoacidosis.Correction of circulating blood volume starts with the infusion of 1000 ml of 0. 9 percent sodium chloride for the first hour followed by the infusion of 2000 ml to 8000 ml for the next 24 hours. tax clients sk in turgor, weight and hematocrit because these result serve as markers for the efficacy of intravenous therapy. Potassium must also be monitored because this electrolyte leaves the cells in ketoacidosis. When transaction with this, several points must be considered during the perspicacity and intervention phase. Frequently assess the patients urine output.Take note of the standard of urine when administering potassium to the client. If the urine is less than 30 ml per hour, halt the cheek of the potassium and notify the physician immediately. forever monitor the client for signs of hyperkalemia (oliguria, weakness, bradycardia, cardiac arrest) and hypokalemia (weakness, paralytical ileus, cardiac arrest). Hyperkalemia may ensue for the first 4 hours of word while hypokalemia may develop after 4 hours up to 24 hours. Monitor the clients ECG and take note of T wave.Its flattening or inversion may correspond hypokalemia while peaking of T wave may indicate hyperkalemia (Brunner , OConnell Smeltzer and Suddarth, 2008). Medications for Diabetes According to Hanas (2007), the American Diabetes acquaintance instituted the individualization of blood glucose goals, with goals higher to those individuals with frequent hypoglycemic attacks. Suggestions were also made on the level of blood glucose for each age group. Jodie, a 17 year old teenager, belongs to the callow group (13-19). It was stated that in the first place meals, an ideal blood glucose level is 5-7 mmol/L or 90-130 mg/dl.At bedtime or overnight, she must have a blood glucose level of 5-8 mmol/L or 90-150 mg/dl. To achieve this goal, Jodie is prescribed with Humalog and Levemir in order to despatch the entry of glucose in the cells thereby preventing the increase of glucose level in the blood. Humalog is a fast- or speedy acting insulin analog that takes work on the body after injecting it. Since it is an analog, it considered as a variation of human insulin and tends to simulate its action fro m the time it is secreted by the pancreas.When taking this medicate, inform the client to use disposable, barren needles or pen. Rotate the injection sites to prevent complications like lipodystrophy. Take this drug at the same time every day. portion a 15 minute border in the lead taking a meal prior to its brass section. To prevent hyperglycemia, take this drug with long acting insulin such as the Levemir (Griffith and Moore 2006). Instruct the patient to seek medical attention immediately if she experiences symptoms such as rash, hive, intense itching, and difficulty in vivacious after taking a dose.This suggests an anaphylaxis answer and is life-threatening. Although infrequent, instruct the patient to take quick-acting sugar such as honey or fruit juice whenever she experiences excessive hunger, insensate sweats, insensate skin, shakiness, chills, or vision changes. This signifies that she is experiencing low blood sugar or hypoglycemia. On the other hand, Levemir is long-acting, man-made insulin that may finish for 24 hours after administration. Instruct patient to use only Levemir when the vial appears to be colorless and clear. Presence of air bubbles is considered normal.However, do not administer the drug if it looks colored, squashy or thickened. Inject drug into subcutaneous part of the body such as the stomach, thighs, and upper arms. Just like in Humalog, rotate the injection sites to prevent lipodystrophy. The patient may also experience hypoglycemia and its preaching is the same as those of Humalog (Novo Nordisk, Inc. 2009). When taking this drug, instruct her to avoid intake of alcohol as this may increase the effect of insulin resulting to blood glucose problems (Griffith 2006). One should also take note on the time Levemir will take effect.Levemir injected at bedtime or 10 pm (for multiple injection therapy) will have its effect during the night and eat. It can also be use as a two dose treatment one in the morning and one in t he dinner. Insulin injected in the morning will take effect on the lunch and afternoon while insulin injected during dinner will take effect on eve and night. Bedtime snack is necessary then to avoid night time hypoglycemia (Hanas 2007). It is also necessary to take insulin originally meals. When taking Humalog as pre-breakfast insulin, it is better if Jodie should monitor her blood glucose.The time elapsed before the administration of pre-breakfast insulin depends on the level of blood glucose she has in the morning. Blood Glucose Levels Rapid Acting Insulin (Humalog) usual or Short Acting Insulin mmol/L mg/dl < 3 < 55 After the meal Just before 3 5 55 90 Just before 15 minutes before 5 10 90 180 Just before 30 minutes before 10 14 180 250 10 minutes before 45 minutes before ? 14 ? 250 20 minutes before 60 minutes before Source Hanas, R. (2007).Type 1 Diabetes in Children, Adolescents, and Young Adults How to become an knowing on your own diabetes (3rd ed. . United ground Class Publishing Ltd. Checking blood glucose before lunch is also necessary. When using rapid acting insulin, a blood glucose reading taken two hours after breakfast is enough. Blood Glucose Measure < 4 mmol/L < 70 mg/dl reduce the insulin dose at breakfast by one to two units > 8 mmol/L > 145 mg/dl gain the insulin dose at breakfast by one to two units Patient experiences cold sweat, hunger, shakiness (signs of hypoglycemia) between breakfast and lunch. falloff the insulin dose at breakfast by one to two units Source Hanas, R. (2007).Type 1 Diabetes in Children, Adolescents, and Young Adults How to become an undecomposed on your own diabetes (3rd ed. ). United terra firma Class Publishing Ltd The Concept of psychological science in Diabetes Adolescence is the time during which an individual attempts to work up their identity and begin involving themselves into sexual relationships. As an juvenile grew, the client will begin to take responsibilities with his or her action. Add up to these responsibilities are those involving their management of diabetes. The challenge here does not only involve the stripling but also the health care provider and the family itself.Adolescent are in the sit wherein they are faced with developmental tasks indispensable to accomplish in addition to the need of managing their lives with diabetes. health care providers and family must also consider their actions to make sure that treatment and regimens do not interfere with age-related activities of the immature thereby allowing growth and development (Snoek and mule skinner 2005). Several complications in diabetes are also found to be associated with poor parental interaction of the childishs diabetes management. DKA is one of these complications.Snoek and Skinner (2005) revealed that individuals belonging to a family that lacks deliver and warmth are typical to hose patients who have DKA. Moreover, diabetic individuals who have receptive family probl ems and lack of parental participation in the treatment have a aspiration to belong in this population with DKA. It was also linked that the possibility of child annoyance (physical, sexual or social) may be triggering factor an adolescent ran away from home skipping his/her dose of insulin. Another possibility is that an adolescent is undergoing the phase of rebellion or rejection.Lifestyle management for teenagers with diabetes may result to resentful feelings as well as the stage of rejection. Consequently, the adolescent omits his/her insulin dose but this is considered to be part of how an adolescent adopts to his/her life of a diabetic person (Snoek 2005). To provide solutions with this problem, a schedule telephone call every two to three weeks may be used to provide assistance and support to the patient through the use of problem solving techniques. Motivational interviewing (MI), which is a collaborative come out between patient and the health care provider, can also be utilized.It is a directive approach that aims to resolve patients anxiety and ambivalence regarding diabetic management by supporting the adolescent and respecting their decisions regarding diabetes management (Miller and Rollnick 2005). With this, an individual will musical theme less worry and anxiety, and satisfaction with the present life and a more supportive outlook (Snoek 2005). Patient Education get on Educational tools are used to publicize information and knowledge in order to maximize the management of blood glucose and prevent complications from it.Since no study shows which type of pedagogy methods is appropriate for education, its approach must be varied but is well fit to the age of the child and the needs of the family. It must not be too uncompromising that it invokes confusion and failure resulting to distress and damage on the part of the adolescent and family (Funnel and Anderson 2004). Health education tools may accept the use of food pyramid and plate models that will advocate the basics of nutrition and healthy eating habits.Extensive patient education may also be necessary for adolescents and the families to help them estimates the amount of carbohydrates in foods, its exchange or portions. Education can also include guides on how to read food labels and how to select the nutritional content of food. Several methods are also instituted to facilitate adolescents learning in measuring carbohydrates. convert or portion system, carbohydrate counting, and glycemic index and glycemic load are some of these methods (Smart 2009).