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Patients on hemodialysis who have type 2 diabetes mellitus are challenged by complex diet prescriptions and demanding selfcare practices. The hemodialysis regimen itself makes diabetes management difficult. These patients are at risk of hypoglycemia and hypoglycemia unawareness. This article alerts nephrology nurses to these issues and to their role in the process of appropriate interventions. The benefit of nurses and dietitians collaboratively developing care plans is discussed. Diet prescriptions and self-care management screening questions are provided.
The diet prescription for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD) requiring hemodialysis (HD) is complex (Canadian Association of Nephrology Dietitians, 2008). Research by Raimundo, Ravasco, Proenca, and Camilo (2005) explored quality of life and nutrition in 60 patients on HD. These authors found a positive relationship between optimal nutrition and quality of life. As part of the nephrology care team, a registered dietitian (RD) completes nutritional assessments, explores the determinants of patients' eating behaviors with patients, and develops nutritional care plans. The HD regimen facilitates frequent nurse-patient interaction, allowing registered nurses (RNs) to be better able to identify diet and DM management issues. This article alerts nephrology RNs to the complexity of dietary prescriptions and DM self-management, and the benefits of a multidisciplinary team approach in care planning with these patients is discussed.
Case Study
Mrs. T is a 72-year-old female with type 2 DM and CKD requiring HD. Her DM is treated with insulin. The patient's DM is also complicated by gastroparesis resulting in chronic diarrhea. She has had elevated serum potassium levels for the last 6 months. Mrs. T has HD 3 times weekly for 3 hours in the morning. She complains to the RN of frequent hypoglycemic episodes after HD treatments. The RN learns from the patient that she does not eat or drink before her HD sessions to avoid having a bowel movement during the treatment. Due to fasting hyperglycemia, Mrs. T takes her regular dose of rapid-acting insulin in the morning. Mrs. T tells the RN that she drinks orange juice after her HD treatment because of hypoglycemia. The RN identifies the patient's knowledge deficit of insulin action, appropriate treatment of hypoglycemia, and continued risk of recurring hypoglycemia and elevated potassium levels. In collaboration with an RD, a plan...