Nancy Moline – Improving Diabetes Management

The bottom line is that we must do better. Your role as a bedside nurse in identifying and managing hyperglycemic patients is crucial.

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Nancy Moline – Improving Diabetes Management

Description:

• Strategies to Reduce the Incidence of Hypo & Hyperglycemia in the Acute Patient
• Critical Interventions for Patients in Crisis
• How to treat special populations: There are simple formulas that can be used
• The Importance of Dosing & Timing
• Tips & Tools You Can Put into Practice the Next Day

Even patients with diabetes were not given glucose control until recently in hospitals. We didn’t realize 1 out of every 3 patients we were caring for was potentially suffering the consequences of uncontrolled hyperglycemia and, worse, these unknown patients were experiencing higher mortality rates after discharge. We must do better. You, the bedside nurse play an important role in managing hypo and hyperglycemic patient.

This seminar will address issues you face in the hospital and give answers to questions you won’t find in any textbook. Imagine being able see a single flowsheet to explain why your patient experiences persistent hypoglycemia. Expert, Nancy MolineRN, M.Ed. CDE. She will share the management tips and tricks she has learned through her vast experience, and increase your knowledge of the complexities surrounding diabetes. You will learn new strategies and tools to improve outcomes for your patients with diabetes, or not.

OUTLINE

Glycemic Targets For Hospitalized Patients

• Clear interpretation of AACE & ADA guidelines
• Limit adjustments for critically ill patients
• Non-Critical patients: Is it too high?

Recognizing Hypoglycemia Symptoms

• Hypoglycemic unawareness – How can we miss this?
• Interventions that influence outcomes
• 15/15 Rule
• Timing and Dose: The bad, the good, and the ugly
  • IV dextrose
  • Glucagon

Reduced Hypoglycemia

• Finger sticks & technique – it does matter!
• Important timing for pre-meal & correction insulin
• The nurse’s role in ensuring carbohydrate-Consistent meals

Symptoms & Critical Interventions for Hyperglycemia

• The differences of DKA & HHNK
• Diabetic Ketoacidosis
  • Complex metabolic process
  • Identify the patient at greatest risk
  • To avoid complications, manage fluid replacement
  • Insulin drips
  • Critical labs & acute management
• Nursing Management HHNK
  • Identify the symptoms
  • Don’t forget your ABCs
  • Common laboratory pitfalls
  • Restoring the balance of your electrolytes

Acute Hyperglycemia: The Consequences

• Addressing & managing new wound infections
• The dangers of:
  • Atypicalities in the platelet
  • Inflammatory cytokine reaction
• The patient & the facility at risk:
  • Poor patient outcomes
  • Readmissions
  • Extended stay
• Insulin resistance

Use a simple formula to treat special populations

• The patient received new steroids
• Tube feeding adjustments
• TPN: The effects of diabetes on patients
• Considerations for patients with R-U-500 units of insulin

Insulin for Improved Control of Glucose

• Type 1 vs. Type 1 vs. Type 2 guidelines
• Insulins are best acted upon immediately
• Calculating Basal/ Bolus Insulin
• Miami 4/12 Rule
• Correction scales that are based on insulin sensitivity

Hospital Setting Oral Agents

• NPO vs. eating status
• Metformin Precautions

Safety issues with Insulin Pump Management

• Patient exclusion criteria
• Recognizing pump problems
• When should you remove pumps?

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System Improvements Have a Positive Impact on Patient Outcomes

• Standardized corrections scales that are based on insulin sensitivity
• Treatment protocols for hypoglycemia
• Physician orders insulin initiation
• Carbohydrate labels on snack/meal trays

It all comes together

• Case Studies: What went wrong and what went right
• Solutions to problems with the glucose accordion report

OBJECTIVES

1. Breakdown glycemic targets for the hospitalized patient
2. Identify hypo/hyperglycemia symptoms
3. Communicate the metabolic consequences for acute hyperglycemia
4. Use a consistent approach to glucose management for patients who are on steroids, tube feedings, or TPN
5. To achieve optimal glucose control, calculate basal/bolus (prandial).
6. Discuss 2 ways that the bedside nurse can help reduce hypoglycemia at the hospital
7. Analyze the hospital’s use of oral agents
8. Safety issues when using insulin pumps in acute care settings
9. Communication 2 system improvements that positively impact patient outcomes