Curing Diabetes

The treatment of autonomic neuropathy depends on the patient’s signs and symptoms and the body organ affected. However, blood glucose control is helpful no matter which organ is affected. Gastroparesis can make it difficult to balance insulin doses with food absorption. Thus, a patient should monitor her blood glucose levels before and after meals and adjust her insulin dosage. Short-acting insulin, such as Lispro, may not be appropriate for a patient with delayed gastric emptying. That’s because this type of insulin begins to work in 5 to 15 minutes, when food may not yet be available.

If your patient develops constipation, treatment includes adequate fluid intake; increased physical activity; increased fiber intake; stool softeners, such as psyllium; judicious use of laxatives; and drugs, such as metoclopramide or cisapride, to stimulate gastric motility.

If your patient has diarrhea, her physician may prescribe drugs to slow intestinal motility, including loperamide, codeine, or diphenoxylate hydrochloride with atropine. The physician also may prescribe a high-fiber diet and psyllium to increase stool bulk and consistency. If your patient has diarrhea related to overgrowth of intestinal bacteria, her physician may prescribe a broad-spectrum antibiotic with anaerobic coverage, such as tetracycline or metronidazole. Your patient may benefit from biofeedback, relaxation, and bowel training, so discuss these treatment options with the physician.

A patient with diarrhea may benefit from a liquid, low-fat diet consisting of several small meals a day. This diet is effective when used with drugs taken one-half hour before eating. If your patient has severe diarrhea, the physician may prescribe total parenteral nutrition or jejunostomy tube feedings.

If your patient has orthostatic hypotension, treatment includes increasing her venous pressure by using supportive elastic body stockings applied while she’s lying down. Hypovolemia can be corrected by good blood glucose control, adequate salt intake, or fludrocortisone. The physician may prescribe a drug, such as ephedrine, to increase the heart rate and blood pressure through vasoconstriction.

No treatment is available for cardiac denervation. However, if the patient has periods of sustained sinus bradycardia or heart block that produce life-threatening symptoms, such as severe hypotension, she may need a permanent pacemaker. The physician may prescribe theophylline and terbutaline to increase the patient’s resting heart rate.

For a patient with bladder dysfunction, treatment focuses on improving bladder function and preventing UTls. Specific interventions may include treatment with antibiotics for UTIs or a parasympathomimetic drug, such as bethanechol, to improve bladder nerve contraction.

More Facts

Your teaching topics depend on your patient’s specific treatment. For GI dysfunction, teach her about her diet and meal planning. Advise her to check her blood glucose levels frequently, and reinforce the importance of using blood glucose levels to detect hypoglycemia and hyperglycemia. To promote optimal GI function, instruct your patient to consume enough fluid and fiber to prevent constipation. Also, advise her to use laxatives judiciously. Teach her relaxation exercises and biofeedback techniques.

Teach your patient with a dysfunctional bladder to schedule urination every 2 hours to help keep her bladder empty and to reduce the risk of UTI. Review the signs and symptoms of UTI, such as dysuria, fever, and chills, and tell her to contact her physician immediately if she experiences them. Teach her Crede’s method to help empty her bladder: She should place a cupped hand directly over her bladder, push in and down, and then massage her bladder to empty it. Also, teach her to palpate her bladder to check for fullness. If your patient must perform self-catheterization, teach her clean technique.

If your patient doesn’t have a prescription for glucagon, talk with the physician. Make sure the patient’s family and friends know how and when to administer glucagon and when to call for help.

Advise your patient with abnormal pupillary response to use a night-light and keep a flash­light by her bed in case she needs to get up during the night. Also tell her to avoid driving at night. Inform her that her abnormal pupil response and decreased peripheral sensation may cause her to lose her sense of balance easily. Advise her to keep her environment well lit and free from clutter.

Filed under: Chronic Complications