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Implementing self-care plans for diabetes -

It's also how much you eat and the types of food you combine in meals and snacks. Learn about planning balanced meals. A healthy-eating plan includes knowing what to eat and how much to eat. Two common ways to plan meals are carbohydrate counting and the plate method. Ask your healthcare professional or a registered dietitian if either type of meal planning is right for you.

Understand carbohydrate counting. Counting carbs involves keeping track of how many grams of carbohydrates you eat and drink during the day. If you take diabetes medicine called insulin at mealtimes, it's important to know the amount of carbohydrates in foods and drinks.

That way, you can take the right dose of insulin. Among all foods, carbs often have the biggest impact on blood sugar levels. That's because the body breaks them down into sugar, which raises blood sugar levels. Some carbs are better for you than others. For example, fruits, vegetables and whole grains are full of nutrients.

They have fiber that helps keep blood sugar levels more stable too. Eat fewer refined, highly processed carbs. These include white bread, white rice, sugary cereal, cakes, cookies, candy and chips.

Get to know the plate method. This type of meal planning is simpler than counting carbs. The plate method helps you eat a healthy balance of foods and control portion sizes.

Use a 9-inch plate. Fill half of the plate with nonstarchy vegetables. Examples include lettuce, cucumbers, broccoli, tomatoes and green beans.

Divide the other half of the plate into two smaller, equal sections. You might hear these smaller sections called quarters. In one quarter of the plate, place a lean protein.

Examples include fish, beans, eggs, and lean meat and poultry. On the other quarter, place healthy carbohydrates such as fruits and whole grains. Be mindful of portion sizes. Learn what portion size is right for each type of food. Everyday objects can help you remember.

For example, one serving of meat or poultry is about the size of a deck of cards. A serving of cheese is about the size of six grapes.

And a serving of cooked pasta or rice is about the size of a fist. You also can use measuring cups or a scale to help make sure you get the right portion sizes. Balance your meals and medicines. If you take diabetes medicine, it's important to balance what you eat and drink with your medicine.

Too little food in proportion to your diabetes medicine — especially insulin — can lead to dangerously low blood sugar.

This is called hypoglycemia. Too much food may cause your blood sugar level to climb too high. This is called hyperglycemia. Talk to your diabetes health care team about how to best coordinate meal and medicine schedules. Limit sugary drinks.

Sugar-sweetened drinks tend to be high in calories and low in nutrition. They also cause blood sugar to rise quickly. So it's best to limit these types of drinks if you have diabetes. The exception is if you have a low blood sugar level.

Sugary drinks can be used to quickly raise blood sugar that is too low. These drinks include regular soda, juice and sports drinks. Exercise is another important part of managing diabetes. When you move and get active, your muscles use blood sugar for energy. Regular physical activity also helps your body use insulin better.

These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities can improve your blood sugar level. Light activities include housework, gardening and walking.

Talk to your healthcare professional about an exercise plan. Ask your healthcare professional what type of exercise is right for you. In general, most adults should get at least minutes a week of moderate aerobic activity.

That includes activities that get the heart pumping, such as walking, biking and swimming. Aim for about 30 minutes of moderate aerobic activity a day on most days of the week. Most adults also should aim to do strength-building exercise 2 to 3 times a week.

If you haven't been active for a long time, your healthcare professional may want to check your overall health first. Then the right balance of aerobic and muscle-strengthening exercise can be recommended. Keep an exercise schedule. Ask your healthcare professional about the best time of day for you to exercise.

That way, your workout routine is aligned with your meal and medicine schedules. Know your numbers. Talk with your healthcare professional about what blood sugar levels are right for you before you start exercise.

Check your blood sugar level. Also talk with your healthcare professional about your blood sugar testing needs. If you don't take insulin or other diabetes medicines, you likely won't need to check your blood sugar before or during exercise.

But if you take insulin or other diabetes medicines, testing is important. Check your blood sugar before, during and after exercise. Many diabetes medicines lower blood sugar. So does exercise, and its effects can last up to a day later.

The risk of low blood sugar is greater if the activity is new to you. The risk also is greater if you start to exercise at a more intense level. Be aware of symptoms of low blood sugar. These include feeling shaky, weak, tired, hungry, lightheaded, irritable, anxious or confused. See if you need a snack.

Have a small snack before you exercise if you use insulin and your blood sugar level is low. The snack you have before exercise should contain about 15 to 30 grams of carbs.

Or you could take 10 to 20 grams of glucose products. This helps prevent a low blood sugar level. Stay hydrated. Drink plenty of water or other fluids while exercising. Dehydration can affect blood sugar levels. Be prepared. Always have a small snack, glucose tablets or glucose gel with you during exercise.

You'll need a quick way to boost your blood sugar if it drops too low. Carry medical identification too. In case of an emergency, medical identification can show others that you have diabetes.

It also can show whether you take diabetes medicine such as insulin. Medical IDs come in forms such as cards, bracelets and necklaces. Adjust your diabetes treatment plan as needed. If you take insulin, you may need to lower your insulin dose before you exercise.

You also may need to watch your blood sugar level closely for several hours after intense activity. That's because low blood sugar can happen later on. Your healthcare professional can advise you how to correctly make changes to your medicine.

You also may need to adjust your treatment if you've increased how often or how hard you exercise. Insulin and other diabetes medicines are designed to lower blood sugar levels when diet and exercise alone don't help enough. How well these medicines work depends on the timing and size of the dose.

Medicines you take for conditions other than diabetes also can affect your blood sugar levels. Store insulin properly.

Insulin that is not stored properly or is past its expiration date may not work. Keep insulin away from extreme heat or cold. Don't store it in the freezer or in direct sunlight. Tell your healthcare professional about any medicine problems. If your diabetes medicines cause your blood sugar level to drop too low, the dosage or timing may need to be changed.

Your healthcare professional also might adjust your medicine if your blood sugar stays too high. Be cautious with new medicines. Talk with your healthcare team or pharmacist before you try new medicines.

That includes medicines sold without a prescription and those prescribed for other medical conditions. Providing basal insulin to patients with type 1 diabetes who are NPO helps maintain glycemic control and prevents the onset of DKA.

Perform regular glucose testing and insulin administration in patients who are NPO for extended periods. Patients who are NPO for an extended period require regular monitoring of blood glucose levels to adjust insulin therapy accordingly.

Insulin regimens may include NPH insulin every 12 hours, frequent doses of rapid-acting insulin, or an IV insulin drip. Dextrose infusions are administered to provide calories and limit ketosis. Educate patients on the appropriate selection of clear liquid foods to maintain glycemic control.

Clear liquid diets often include simple carbohydrate foods, such as juice and gelatin desserts, which can cause rapid spikes in blood glucose levels if consumed alone. Providing education on appropriate food choices helps patients make informed decisions to manage their blood glucose levels effectively.

Administer insulin doses at regular intervals aligned with the tube feeding schedule. Tube feeding formulas high in simple carbohydrates can lead to increased glucose levels in patients with diabetes.

Insulin doses should be given regularly, such as NPH every 12 hours or regular insulin every 4 to 6 hours, to manage glycemic control effectively during continuous tube feedings.

Coordinate with the healthcare team regarding any plans to temporarily discontinue tube feedings. Inadvertent or purposeful discontinuation of tube feedings can result in hypoglycemia in patients receiving insulin.

Discussing and planning ahead with the medical team allows for adjustments in insulin dosage or the administration of IV dextrose to prevent hypoglycemia during the temporary discontinuation of tube feedings. Monitor for and respond promptly to unexpected problems with the tube feeding. Unforeseen issues with the tube feeding, such as tube dislodgement, clogging, or discontinuation due to gastric contents, can impact glycemic control.

Promptly notifying the primary provider, increasing the frequency of blood glucose level assessments, and administering IV dextrose when indicated help prevent and manage hypoglycemia during these situations.

Administer IV insulin added to the parenteral nutrition container for patients receiving continuous parenteral nutrition. Continuous parenteral nutrition can contribute to changes in blood glucose levels.

Administering IV insulin as part of the parenteral nutrition helps regulate glycemic control and prevent hyperglycemia. Coordinate subcutaneous insulin administration with the infusion schedule of limited-duration parenteral nutrition.

When parenteral nutrition is infused over a limited number of hours, subcutaneous insulin should be administered to align peak times of insulin action with the times of parenteral nutrition infusion. This synchronization helps maintain stable blood glucose levels during the infusion period.

Monitor blood glucose levels regularly in patients receiving parenteral nutrition. Regular monitoring of blood glucose levels is essential to assess glycemic control and guide insulin administration. Monitoring allows for timely adjustments in insulin dosage and prevents hypo- or hyperglycemia in patients receiving parenteral nutrition.

Monitor blood glucose levels closely during periods of physiologic stress, such as infections or surgery. Physiologic stress can contribute to hyperglycemia in patients with diabetes. Close monitoring of blood glucose levels helps identify any fluctuations and allows for timely intervention to prevent complications such as diabetic ketoacidosis DKA or hyperosmolar hyperglycemic state HHS.

Emotional stress related to hospitalization can negatively impact diabetic control. Providing emotional support helps alleviate stress and promote psychological well-being, which can indirectly contribute to better diabetic control.

Educate the patient about the relationship between stress and glucose levels, emphasizing the importance of maintaining the diabetes treatment plan during times of stress. Patients with diabetes need to understand that emotional stress can affect their glucose levels.

By educating them about this relationship, they can be empowered to adhere to their treatment plan even during stressful periods, reducing the risk of glucose fluctuations and complications.

Teach stress management techniques and coping strategies to the patient. Learning strategies for minimizing and coping with stress is crucial for patients with diabetes. By providing education on stress management techniques, such as deep breathing exercises, mindfulness, or engaging in hobbies, nurses empower patients to effectively manage their stress levels and maintain better diabetic control.

Encourage the patient to engage in healthy coping mechanisms as part of diabetes self-management. Healthy coping strategies are essential for managing diabetes effectively. Encouraging patients to engage in activities such as regular exercise, social support, relaxation techniques, and seeking professional help if needed promotes overall well-being and glycemic control.

Provide diabetes education that includes information on stress management and coping strategies. Diabetes education should encompass not only the management of glucose levels but also the skills to cope with stress. By including stress management and coping strategies in diabetes education, patients are equipped with the tools to navigate stressful situations while maintaining diabetic control.

Effective insulin management is vital for optimal diabetes control. Individuals with type 1 diabetes rely on lifelong insulin administration, while those with type 2 diabetes may require insulin if other treatments fail.

Regular blood glucose monitoring and appropriate insulin dosage adjustments are necessary for maintaining stable levels. By managing insulin effectively, individuals can reduce the risk of complications and improve their overall quality of life.

Assessing their readiness helps in selecting an appropriate insulin regimen that matches their lifestyle and preferences. Insulin therapy may involve multiple injections, blood glucose monitoring, and record-keeping. It is essential to ensure that the patient knows how to properly administer insulin injections.

Administer insulin injections as prescribed. In type 1 diabetes, exogenous insulin is necessary for life due to the inability of the body to produce insulin.

In type 2 diabetes, insulin may be required on a long-term basis if other treatment options are ineffective or when insulin deficiency occurs. Insulin plays a crucial role in regulating blood glucose levels, preventing complications associated with high or low sugar levels. The different types of insulin are as follows:.

Rapid-acting insulin analogs [lispro insulin Humalog , insulin aspart] Has a clear appearance. Have an onset of action within 15 minutes of administration. The duration of action is 2 to 3 hours for Humalog and 3 to 5 hours for aspart.

Patient must eat immediately after injection to prevent hypoglycemia. Short-acting insulin regular insulin [regular Humulin R ] Short-acting insulins have a clear appearance, has an onset of action within 30 minutes of administration, duration of action is hours.

Regular insulin is the only insulin approved for IV use. Intermediate-acting insulin NPH insulin [neutral protamine Hagedorn NPH , insulin zinc suspension Lente ] They appear cloudy and have either protamine or zinc added to delay their action.

Onset of action for the intermediate-acting is one hour after administration; duration of action is 18 to 26 hours. This type of insulin should be inspected for flocculation, a frosted-whitish coating inside the bottle.

If frosted, it should not be used. Long-acting insulin [Ultralente, insulin glargine Lantus ] Have a clear appearance and do not need to be injected with a meal. Long-acting insulins have an onset of one hour after administration, and have no peak action because insulin is released into the bloodstream at a relatively constant rate.

Duration of action is 36 hours for Ultralente is 36 hours and glargine is at least 24 hours. They cannot be mixed with other insulin because they are in a suspension with a pH of 4, doing so will cause precipitation.

Providing information about various insulin regimens empowers the patient to make an informed decision. By understanding the potential benefits and costs of each regimen, the patient can actively participate in the selection process. Teach the patient about meal planning and its impact on insulin requirements.

Proper meal planning plays a significant role in managing blood glucose levels. The nurse should educate the patient on the relationship between food intake and insulin doses.

For instance, rapid-acting or short-acting insulins are intended to cover the increase in glucose levels after meals, while intermediate-acting insulins help regulate subsequent meals.

Provide education on self-monitoring of blood glucose SMBG and carbohydrate counting. SMBG helps patients monitor their blood glucose levels and make necessary adjustments to insulin doses. Teaching carbohydrate counting enables patients to match insulin doses to their food intake, providing flexibility in timing and content of meals.

Instruct patients on practical information such as where to purchase and store insulin, syringes, and glucose monitoring supplies, as well as when and how to contact their primary healthcare provider.

Practical information ensures patients have the necessary tools and resources for self-management and know when to seek professional assistance. Instructing the patient on proper timing of insulin administration. Different insulin preparations have varying onset, peak, and duration of action.

It is crucial to educate the patient about the timing of insulin injections to ensure optimal glucose control. For example, rapid-acting insulins should be administered shortly before meals, while basal insulins should be taken consistently to maintain glucose levels irrespective of meals.

Monitor for signs and symptoms of hypo- and hyperglycemia. Diabetes management aims to maintain blood glucose levels within a target range. Hypoglycemia low blood sugar and hyperglycemia high blood sugar are potential complications.

Regular monitoring and early detection of these conditions allow for prompt interventions to prevent further complications. Provide support and education on preventing and managing hypoglycemia. Intensive insulin regimens pose a higher risk of hypoglycemia. Educating the patient about the signs, symptoms, and management of hypoglycemia helps prevent and address this potential complication.

Educate patients on the importance of preparing insulin injections consistently and avoiding errors in dosing or using the wrong type of insulin. Consistent preparation of insulin injections minimizes the risk of dosing errors and ensures proper insulin administration.

Accurate preparation is crucial for achieving glycemic control and preventing adverse effects. Explain the recommended order for drawing up mixed insulins, with regular insulin being drawn up first. Drawing up regular insulin before other types of insulin helps ensure accurate dosing and maintains consistency in technique.

Following a specific order reduces the risk of incorrect insulin doses and promotes safe administration. Emphasize the importance of not injecting cloudy insulin into a vial of clear insulin to prevent contamination and alteration of insulin action.

Injecting cloudy insulin into a vial of clear insulin contaminates the entire vial, affecting its therapeutic properties and potentially leading to inconsistent glycemic control.

Patient adherence to proper injection techniques helps maintain insulin integrity and efficacy. Educate patients on alternative options if they have difficulty mixing insulins, such as using premixed insulins, prefilled syringes, or taking separate injections.

Providing information about alternative options supports patients in finding a suitable method for insulin administration that aligns with their individual needs and capabilities.

These options ensure accurate dosing and simplify the injection process for patients who may have difficulties with mixing insulin. Educate patients to refrigerate all unused insulin vials, including spare vials or pens, to maintain their effectiveness.

Refrigeration helps preserve the potency of insulin and prevents degradation that can occur due to temperature fluctuations, ensuring the insulin remains effective for use.

Advise patients to avoid exposing insulin to extreme temperatures, such as freezing, direct sunlight, or hot car interiors. Extreme temperatures can compromise the efficacy of insulin, leading to potential fluctuations in blood glucose control.

It is important to protect insulin from temperature extremes to maintain its therapeutic value. Instruct patients to keep the insulin vial in use at room temperature to reduce the risk of local irritation at the injection site. Cold insulin can cause discomfort and local irritation upon injection, which can be minimized by allowing the insulin vial to reach room temperature.

This promotes patient comfort and improves adherence to insulin therapy. Educate patients about the storage duration of insulin vials, advising that if a vial will be used within 1 month, it can be kept at room temperature.

Insulin can be safely stored at room temperature for up to one month without compromising its effectiveness. This knowledge empowers patients to manage their insulin storage appropriately and ensures they have access to insulin that is ready for use. Instruct patients to gently mix cloudy insulins by inverting the vial or rolling it between their hands before drawing the solution into a syringe or pen.

Cloudy insulins contain particles that need to be evenly distributed throughout the solution. Mixing the insulin ensures a consistent dose and promotes accurate administration. Emphasize the importance of checking the expiration date on all types of insulin before use.

Expired insulin may have reduced efficacy or potency, which can lead to suboptimal blood glucose control. Checking the expiration date helps ensure patients use insulin that is safe and effective.

Teach patients to inspect bottles of intermediate-acting insulin for flocculation, which appears as a frosted, whitish coating inside the bottle. Flocculation is an indication that the insulin has been exposed to extreme temperatures and may have lost its effectiveness.

Discarding insulin with flocculation helps prevent administering compromised insulin and maintains proper glycemic control. Ensure that the appropriate syringe size is selected to match the insulin concentration being used and on the different sizes of insulin syringes available 1mL, 0.

Selecting the correct syringe size is crucial to accurately measure and draw up the prescribed insulin dose. Using syringes with the appropriate capacity ensures accurate insulin administration and helps prevent dosing errors. Providing information about syringe sizes and their markings helps patients understand the available options and choose the most suitable syringe for their insulin needs.

Awareness of unit increments promotes accurate measurement and dosing. Instruct patients on the importance of using a new, disposable needle for each insulin injection. Using a new needle for each injection helps maintain needle sharpness, reduce discomfort, minimize the risk of infection, and ensure accurate insulin delivery.

It is essential for patient safety and proper injection technique. Advise patients to keep the needle capped when not in use to maintain cleanliness and sterility. Keeping the needle capped when not in use helps prevent contamination, maintain needle sterility, and reduce the risk of infection.

It ensures a safe and hygienic insulin administration process. Emphasize the importance of not sharing insulin syringes with others to prevent cross-contamination and the spread of infections. Sharing syringes can transmit bloodborne infections, including viral diseases such as HIV and hepatitis.

Educating patients about the risks associated with sharing syringes promotes safe injection practices and protects against potential health hazards. Instruct patients on proper syringe disposal techniques, such as clipping off the needle or using a device that safely contains and disposes of the needle.

Proper syringe disposal helps prevent accidental needlestick injuries, protects others from potential harm, and ensures the safe management of medical waste. Teaching patients appropriate disposal methods promotes community safety and adherence to waste management regulations. Provide guidance on local regulations and resources for disposing of used syringes, including contacting the refuse company or waste authority for guidance.

Proper disposal of used syringes is essential to prevent environmental contamination and comply with local waste management regulations. Informing patients about available resources helps them navigate safe disposal practices effectively.

Educate patients on safe syringe transport during travel, advising them to pack used syringes in a secure container to prevent accidental needlesticks. Traveling with used syringes requires careful handling to avoid injuries and maintain personal and public safety.

Providing instructions on proper syringe transport reduces the risk of accidental needlesticks during travel. Insulin pump therapy is suitable for patients who desire continuous subcutaneous insulin infusion and are willing to actively participate in self-management.

Provide extensive education on insulin pump use and self-management of blood glucose and insulin doses. Insulin pump therapy requires thorough education to ensure proper understanding and safe use of the device. Educating the patient about insulin pump operation, insertion site care, troubleshooting techniques, blood glucose monitoring, and calculating insulin doses based on carbohydrate counting promotes effective self-management.

Teach the patient about potential risks and complications associated with insulin pump therapy. Patients need to be aware of potential risks and complications, such as occlusions in the infusion set or tubing, interruptions in insulin flow, and the increased risk of ketoacidosis.

Educating patients about recognizing signs of occlusions, administering manual injections when needed, and seeking prompt medical attention for any concerns helps minimize risks and promote patient safety. Instruct the patient on proper care, maintenance, and replacement of the insulin pump.

Proper care and maintenance of the insulin pump, including regular changing of infusion sets, is essential for optimal function and prevention of complications. Teaching the patient about proper hygiene, safe storage, battery replacement, and when to seek technical support helps ensure uninterrupted insulin delivery and device performance.

This monitoring allows for adjustments in insulin dosages and troubleshooting of any issues to maintain optimal glucose control.

Provide support and addressing concerns related to wearing the pump. Some patients may find wearing the insulin pump for 24 hours a day inconvenient or may have concerns about its visibility. Offering support, addressing concerns, and discussing options for temporary disconnection e.

Insulin pens are suitable for patients who need to inject one type of insulin at a time or can use premixed insulins. Instruct the patient on proper insulin pen technique and safety measures.

Proper technique in using insulin pens ensures accurate dosage delivery and minimizes the risk of complications. Education on how to load the insulin cartridge, dial the appropriate dose, attach the disposable needle, and perform the injection helps the patient use the device effectively and safely.

Teach the patient about storage and maintenance of insulin pens. Insulin pens should be stored properly to maintain the integrity of the insulin and the device. Educating the patient on storage conditions, such as avoiding extreme temperatures, and the need for regular cleaning and replacement of needles promotes optimal performance of the insulin pen.

This monitoring allows for adjustments in insulin dosages as needed to maintain optimal glucose control. Jet injectors are an alternative to needle injections for delivering insulin. Provide thorough training and supervision for the patient when initiating jet injector use. Proper training is crucial when using jet injectors to ensure accurate and safe insulin delivery.

Providing comprehensive education on how to operate the device, maintain hygiene, and troubleshoot any issues helps the patient use the jet injector effectively and minimizes the risk of complications. Educate the patient about the differences in insulin absorption rates, peak activity, and insulin levels with a jet injector.

Jet injectors may result in differences in insulin absorption rates compared to traditional needle injections. Educating the patient about these variations helps them understand the potential differences in insulin action and adjust their self-management strategies accordingly. Advise the patient about the possibility of bruising associated with jet injector use.

Some patients may experience bruising at the injection site when using jet injectors. Informing the patient about this potential side effect helps manage their expectations and promotes early identification of any complications or adverse reactions.

Insulin administration can sometimes lead to local and systemic allergic reactions, with local reactions causing redness, swelling, tenderness, and wheals at the injection site. Systemic reactions are rare but can result in generalized urticaria or even anaphylaxis. Assess and monitor for local allergic reactions at the injection site.

Local allergic reactions, such as redness, swelling, tenderness, or wheal formation, can occur after insulin injections. Regular assessment of injection sites helps identify and monitor any allergic reactions. If reactions persist, an alternative type of insulin can be prescribed.

Educate the patient about systemic allergic reactions to insulin and the appropriate response. Although rare, systemic allergic reactions can occur, presenting as generalized urticaria hives or even anaphylaxis.

Patients should be aware of these potential reactions and know to seek immediate medical attention if they experience any symptoms. Desensitization with gradually increasing insulin doses may be necessary for treatment. Educate the patient about insulin lipodystrophy and the importance of rotation of injection sites.

Lipodystrophy refers to localized reactions at injection sites, including lipoatrophy loss of subcutaneous fat or lipohypertrophy fibrofatty masses. Using human insulin has greatly reduced the occurrence of lipodystrophy.

Patients should be educated about the importance of rotating injection sites to prevent the development of lipohypertrophy and delayed insulin absorption. Monitor for insulin resistance and collaborating with the healthcare team to adjust insulin doses.

Insulin resistance may occur in some patients with diabetes, requiring higher insulin doses for adequate glycemic control. Regular monitoring of blood glucose levels and close collaboration with the healthcare team allow for adjustments in insulin doses to address insulin resistance and control diabetes symptoms effectively.

Provide education on the causes of morning hyperglycemia and strategies to address it. Morning hyperglycemia can result from the dawn phenomenon , insulin waning, or the Somogyi effect.

Educating the patient about these causes helps them understand the importance of blood glucose monitoring during the night to determine the underlying cause.

Adjustments in insulin doses and timing can be made accordingly to prevent morning hyperglycemia. Teach the patient about proper timing of insulin administration to address insulin waning. Insulin waning refers to a progressive increase in blood glucose levels from bedtime to morning.

Instructing the patient to administer the evening NPH insulin dose at bedtime rather than before dinner helps prevent insulin waning and ensures better glycemic control upon waking.

Oral antidiabetic agents are prescribed for patients with type 2 diabetes who do not respond effectively to medical nutrition therapy MNT and exercise alone. Understanding the different classes of oral antidiabetic agents and how they work can empower the patient to actively participate in their treatment plan and recognize the importance of medication adherence.

Oral antidiabetic agents are used for patients with type 2 diabetes who cannot effectively manage their condition through diet and exercise alone. Oral antidiabetic agents may include:. Second-Generation Sulfonylureas [glipizide Glucotrol , glimepiride Amaryl , glyburide Diabeta ] Sulfonylureas stimulate insulin release from the beta cells in the pancreas.

They improve binding insulin to receptors and may increase number of insulin receptors. They are indicated as adjunct to diet and exercise MNT. They are more potent than first-generation sulfonylureas and can be used in combination with metformin or insulin to improve glucose control.

Biguanides [metformin Glucophage ] Biguanides decreased the product and increases the uptake of glucose in the liver. It is effective in lowering blood glucose and does not cause hypoglycemia as the sulfonylureas do.

It has been associated with development of lactic acidosis and GI distress and long term use may cause vitamin B12 deficiency. Alpha-Glucosidase Inhibitors [acarbose Precose , miglitol Glyset ] inhibit alpha-glucosidase, an enzyme that breaks down glucose for absorption.

Therefore, they delay the absorption of glucose. They have only a mild effect on glucose levels and do not enhance insulin secretion. They are associated with severe hepatic toxicity and GI distress. Non-Sulfonylurea Insulin Secretagogues [repaglinide Prandin , nateglinide Starlix ] Stimulates the pancreas to secrete insulin.

It can be used alone or in combination with metformin to improve control of glucose. Thiazolidinediones or Glitazones [pioglitazone Actos , rosiglitazone Avandia ] Decreases insulin resistance by sensitizing the body to insulin and by stimulating insulin receptor sites to lower blood glucose and improve action of insulin.

Dipeptidyl Peptidase-4 DPP-4 Inhibitors [sitagliptin Januvia , saxagliptin Onglyza , linagliptin Tradjenta ] Slows the breakdown of GLP-1 to prolong the effects of increased insulin secretion, decreased glucagon secretion, and slowed GI emptying ultimately producing improved glucose control.

Glucagon-like Peptide-1 Agonist GLP-1 [liraglutide Victoza , dulaglutide Trulicity ] Enhances glucose-dependent insulin secretion and exhibit other antihyperglycemic actions following their release into the circulation from the gastrointestinal tract. They may also lead to weight loss but can have side effects such as pancreatitis, diarrhea , nausea, and vomiting.

Not suitable for patients with type 1 diabetes. Sodium-Glucose Co-Transporter 2 SGL-2 Inhibitors [dapagliflozin Forxiga , canagliflozin Invokana ] Increases urinary glucose excretion and lowers the renal threshold for glucose.

It is also prescribed to reduce the risk of major cardiovascular events in patients with established cardiovascular disease and type 2 DM. This drug improves glycemic control by decreasing glucose concentration in the blood through increased urinary excretion and reduced renal absorption of glucose.

Educate the patient about the complementary nature of oral antidiabetic agents with other treatment modalities, such as medical nutrition therapy MNT and exercise. Reinforcing the importance of a comprehensive approach to diabetes management encourages the patient to adhere to a balanced diet and engage in regular physical activity, which can enhance the effectiveness of oral antidiabetic agents.

Hyperglycemia resulting from these conditions may require temporary discontinuation of oral antidiabetic agents and initiation of insulin therapy. Regular monitoring helps detect any fluctuations in blood glucose levels and informs appropriate medication adjustments.

Provide education on insulin therapy and its potential use in combination with oral agents, particularly for newly diagnosed patients with type 2 diabetes who have symptomatic hyperglycemia and high blood glucose and A1C levels.

Some patients may require insulin therapy as an adjunct to oral antidiabetic agents to achieve glycemic targets. Educating the patient about insulin therapy helps alleviate any fears or misconceptions they may have and promotes acceptance and adherence to the prescribed treatment regimen.

Emphasize the importance of regular follow-up visits and laboratory tests to evaluate the effectiveness of oral antidiabetic agents and make necessary adjustments. Regular follow-up visits and laboratory tests enable healthcare providers to modify the treatment plan as needed.

Encourage the patient to report any adverse effects or changes in symptoms related to oral antidiabetic agents promptly. Early identification and management of adverse effects or changes in symptoms associated with oral antidiabetic agents are essential to prevent complications and optimize treatment outcomes.

Open communication encourages patients to seek timely medical assistance when needed. Proper nutrition and meal planning are essential for diabetes management. Educating patients about healthy food choices, portion control, and balanced meals can help them achieve and maintain optimal blood glucose levels, lipid profiles, and blood pressure.

Calculations based on age, gender, height, and weight help determine the baseline caloric intake required for weight maintenance and overall health. This individualized approach supports accurate calorie control and ensures nutritional adequacy. Factoring in physical activity provides a more accurate estimation of energy needs and supports the patient in achieving their weight goals.

Subtract to calories from the daily total to promote a safe and gradual weight loss. To promote a 1- to 2-pound weight loss per week, a calorie deficit of to calories is recommended.

This approach supports gradual weight loss, which is associated with better long-term success and reduces the risk of adverse effects.

Simplify meal planning information and provide opportunities for practice and repetition. Some aspects of meal planning, such as using food exchange systems, may be challenging for patients due to intellectual limitations or emotional barriers.

Simplifying information and providing opportunities for practice and repetition can enhance patient understanding and proficiency in meal planning techniques. This approach helps patients develop confidence and competence in managing their dietary choices and fosters long-term adherence.

Balancing the distribution of macronutrients is crucial for maintaining optimal nutrition and supporting blood glucose control. Educate the patient about the recommended percentages of calories from carbohydrates, proteins, and fats.

Providing education on the recommended caloric distribution helps patients understand the importance of balancing macronutrients in their diet. By educating patients about the recommended percentages of calories from carbohydrates, proteins, and fats, nurses empower patients to make informed dietary choices that support blood glucose control, lipid management, and overall health.

Highlight the importance of increased fiber intake for improved blood glucose levels and other health benefits. Increased fiber intake plays a significant role in improving blood glucose levels, lowering cholesterol, and promoting satiety.

Educating patients about the benefits of fiber-rich foods, such as legumes, whole grains, fruits, and vegetables, encourages their inclusion in the meal plan and supports overall dietary and health goals.

Gradually increase fiber intake in consultation with a dietitian to prevent adverse effects. Sudden increases in fiber intake can lead to gastrointestinal discomfort and require adjustments in dosage of insulin or antidiabetic agents to prevent hypoglycemia.

Gradually increasing fiber intake in consultation with a dietitian allows for proper monitoring and adjustment of the meal plan to mitigate potential adverse effects. Educate patients about the use of exchange lists for meal planning. Exchange lists are a commonly used tool in nutritional management for individuals with diabetes.

Educating patients about the concept of exchange lists helps them understand how foods can be organized into groups with similar characteristics, such as calorie content and macronutrient composition.

This knowledge enables patients to create a well-balanced meal plan that maintains consistency in nutrient intake while providing variety in food choices. You can learn more about the Food Exchange List here.

Teach patients how to read nutrition labels and understand carbohydrate content. Reading food labels is an essential skill for patients with diabetes when shopping for food. Understanding the carbohydrate content of foods listed on nutrition labels allows patients to make informed choices and accurately determine the amount of medication needed, particularly for those who require premeal insulin.

Explain the concept of carbohydrate counting and its flexibility in food choices. The right frequency of these checks varies from person to person, but doctors usually recommend monitoring levels before and after meals, at bedtime, and before exercising. People with diabetes who are not taking insulin should also check their blood sugar levels.

Self-monitoring can provide information about the effects of dietary changes, physical activity, and medication on blood sugar levels. There are also continuous glucose monitors , which provide real-time information about blood sugar levels.

These automatically measure levels every 5 minutes through a small sensor inserted under the skin. When a person uses it appropriately, this type of technology can improve health outcomes.

A healthcare team can use at-home blood sugar readings to modify medication, nutrition , and self-management plans. It is important for people with diabetes or prediabetes to achieve and maintain a healthy weight. When doctors closely monitor weight loss progress, a person more likely to achieve their goals.

Research suggests that, among people with excess weight, modest, consistent weight loss can help manage type 2 diabetes and slow the rate at which prediabetes becomes diabetes.

They also noted that making dietary adjustments can lower glycated hemoglobin levels by 0. Nutrition therapy can also lead to improvements in the quality of life.

To facilitate these lifestyle adjustments, the ADA recommend consulting a registered dietitian with expertise in diabetes and weight management. Following a meal plan can be among the most challenging aspects of diabetes self-management. Developing a plan with a registered dietitian who is knowledgeable about diabetes-specific nutrition can help.

For some people, dietary changes alone are not enough to control blood sugar levels. Diabetes is a progressive disease, which means that it can worsen over time. The ADA recommend using a combination of medication and nutrition therapy to reach blood sugar targets.

The basis of meal planning involves portion control and favoring healthful foods. The diabetes plate method is one tool designed to help people control their calorie and carbohydrate intakes.

It involves mentally dividing the plate into three sections. Half of the plate should contain nonstarchy vegetables , a quarter can contain grain-based and starchy foods, and the remaining quarter should contain protein.

Research has shown that exercise can help control blood sugar levels, reduce cardiovascular risk factors, promote weight loss, and improve well-being.

Researchers behind one study found that engaging in a structured exercise program for at least 8 weeks lowered glycated hemoglobin levels by an average of 0.

The ADA recommend exercising for at least 10 minutes per session and getting a total of at least 30 minutes of exercise on most days of the week. If a person exercises every day — or lets no more than 2 days pass between workouts — this may help reduce insulin resistance.

Members of a diabetes healthcare team can help develop and tailor an exercise plan that is safe and effective. In addition to exercising regularly, it is important to avoid spending long periods in a seated position. Breaking up sedentary periods every 30 minutes can help with controlling blood sugar.

The ADA advise all people with prediabetes or diabetes to avoid tobacco products, including e-cigarettes. People with diabetes who smoke have higher risks of cardiovascular disease , premature death, and diabetes complications , as well as less blood sugar control, compared with people who do not smoke.

If a person with diabetes does not take their medication as recommended by a doctor, it can lead to:. A diverse range of issues can contribute to medication nonadherence. Some may relate to psychological, demographic, and social factors.

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