Full Course Description


Improving Diabetes Management

OUTLINE

Glycemic Targets for Hospitalized Patients

  • Clear interpretation of AACE & ADA guidelines
  • Adjusting limits for the critically ill patient
  • Non-critical patients: How high is too high

Recognizing Symptoms of Hypoglycemia

  • Hypoglycemic unawareness: How are we missing this?
  • Interventions that change outcomes
  • 15/15 Rule
  • Timing and Dose: The good, the bad, the ugly
    • IV dextrose
    • Glucagon

Reducing Incidence of Hypoglycemia

  • Finger sticks & technique – it does matter!
  • Critical 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
    • A complex metabolic process
    • Identifying the patient at risk
    • Managing fluid replacement to avoid complications
    • Insulin drips
    • Critical labs & acute management
  • Nursing Management of HHNK
    • Identifying the symptoms
    • Don’t forget your ABCs
    • Common laboratory pitfalls
    • Restoring electrolyte balance

Consequences of Acute Hyperglycemia

  • Addressing & managing new wound infections
  • The dangers of:
    • Platelet abnormalities
    • Inflammatory cytokine response
  • The patient & the facility at risk:
    • Poor patient outcomes
    • Readmissions
    • Increased length of stay
  • Insulin resistance

Treating Special Populations Using a Simple Formula

  • The patient newly prescribed steroids
  • Adjusting for tube feedings
  • TPN: Understanding the effects for the diabetic patient
  • Considerations for patients on R-U-500 insulin

Insulin for Improved Glucose Control

  • Type 1 vs. Type 2 guidelines
  • Action times of insulins
  • Calculating Basal/ Bolus Insulin
  • Miami 4/12 Rule
  • Correction scales based on insulin sensitivity

Oral Agents in the Hospital Setting

  • NPO vs eating status
  • Precautions for Metformin

Safety Issues with Managing Insulin Pumps

  • Patient exclusion criteria
  • Recognizing pump problems
  • When to remove pumps

System Improvements Positively Impacting Patient Outcomes

  • Standardized correction scales based on insulin sensitivity
  • Standard protocols for treating hypoglycemia
  • Physician order sets for insulin initiation
  • Carbohydrate labels on meal trays/snacks

Putting It All Together

  • Case Studies: What went right and what went wrong
  • Solving problems using the glucose accordion flowsheet report

OBJECTIVES

  1. Breakdown glycemic targets for the hospitalized patient
  2. Detect symptoms of hypo/hyperglycemia
  3. Communicate metabolic consequences of acute hyperglycemia
  4. Utilize a standardized approach to managing glucose in patients on steroids, tube feedings and TPN
  5. Calculate basal/ bolus (prandial) insulin dosing to achieve optimal glucose control
  6. Formulate 2 ways the bedside nurse can reduce the incidence of hypoglycemia in the hospital
  7. Analyze the use of oral agents in the hospital setting
  8. Assess safety issues with using insulin pumps in the acute care setting
  9. Communicate 2 system improvements that positively impact patient outcomes
Copyright : 05/19/2017

Advanced Diabetes Management

OUTLINE

New Recommendations

  • American Diabetes Association (ADA)
    • All NEW 2015 Standards of Care
      • BMI Classifications
      • E-cigarettes
  • Immunization Recommendations
  • American Association of Clinical Endocrinologists (AACE)
    • Updates to the Comprehensive
  • Diabetes Algorithm
  • Reimbursement Strategies

Cardiometabolic Disease

  • Dyslipidemia
    • New American College of Cardiology Guidelines
    • Recommended Treatment Based on Risk Factors
  • Critical Lab Values
  • Statin Therapy
  • Non-statin LDL-C-lowering Therapy
  • Fibrates
  • Omega 3
  • Niacin
  • Hypertension
    • Modifications in Diagnostic Criteria
    • Beta-Blockers
    • Calcium Channel Blockers
    • Diuretics
    • Low Dose vs. Aggressive Therapy

Biomechanical Complications

  • New Guidelines for Assessment
  • Foot Exam & Treatment Alterations
  • Skin Assessment
  • Ulcers
    • Strategies for Patient Compliance
    • Recurrence Prevention
  • Neurological Predisposition
    • Peripheral & Autonomic
  • Neuropathies
  • Vascular Considerations
    • Microvascular changes
    • Challenges with Retinopathies

Non-Insulin Medications

  • AACE Profiles & Recommendations
    • Sulfonylureas
    • Meglitinides
    • Thiazolidinediones
    • Biaguanides
    • Alpha-glucosidase Inhibitors
    • DPP-4 Inhibitors
    • SGLT-2 Inhibitors

Blood Glucose Pattern Analysis

  • 2015 Glycemic Targets
  • Adjusting Treatment
  • Utilizing CGM

Individualized Glycemic Treatment Goals

  • Monotherapy
  • Dual Therapy
  • Benefit of Early, Aggressive Control

When to Transition to Insulin

  • Progressive B-cell Failure
  • Insulin Profiles
  • Basal Therapy
  • Intensifying Therapy
  • Benefits of Insulin Pump Therapy
    • New Options
    • Sensor-augmented
    • Closed Loop Therapy

Management Strategies for Acute Complications

  • Diabetic Ketoacidosis (DKA)
  • Hyperglycemic Hyperosmolar Non-ketotic Syndrome (HHNK)
  • Infection
  • Surgery & Hospitalization

Addressing Special Populations

  • Type II in Children/Adolescents
    • Variations in Targets and Therapies
  • Elderly
    • Impact of Co-Morbidities

Putting it All Together

  • AADE-7 Behavioral Goals
  • Strategies for Compliance
  • Motivating Change

OBJECTIVES

  1. Communicate the various pharmacologic treatment options for diabetes.
  2. Breakdown effective new strategies to improve patient outcomes.
  3. Formulate a plan of care for the patient with complications related to diabetes.
  4. Integrate motivational interviewing strategies to facilitate patient behavioral changes.
  5. Evaluate biomechanical treatment strategies to improve patient outcomes.
  6. Assess the new recommendations for cardiometabolic disease.
  7. Develop management strategies for the patient experiencing a diabetic emergency.
Copyright : 12/04/2015