Before being diagnosed and eventually treated for their diabetes, some diabetics experience sight problems due to their disease. These problems may be blurry vision, difficulties to focus and sudden near- or farsightedness. These problems may also be present during the first months of treatment. This might cause unnecessary worry, but is something that occurs to many diabetics, and it is due to the high blood sugar levels, that affect the eyes’ lenses. It is important however that the patient, if he or she is already using contact lenses or glasses, doesn’t walk right away to the local eye care professional to try out new lenses to cure this unexpected problem. When the treatment sets in, and the blood sugar goes back to normal, so does the changes of the lenses, and the vision is very likely to become normal again.

Diabetes patients otherwise usually don’t have any trouble using contacts or glasses, since the disease rarely affect the eyes. Any type of contact lens, like soft lenses or extended-wear lenses, is not likely to cause any problems. It is important however to have regular contact with the eye care professional, to make sure that any eye problems will not return and become permanent.

One complication of diabetes is diabetic nephropathy. A quick and simple way to check renal function is to draw a blood sample for serum creatinine and BUN tests. These tests should be performed when the patient is diagnosed with diabetes.Although the serum creatinine and BUN tests can quickly reveal the patient’s renal function, serum creatinine is the more sensitive indicator. Many extrarenal conditions, such as dehydration, can elevate the BUN level, but serum creatinine changes little except in renal disease. A normal serum creatinine level for an adult ranges between 0.7 and 1.5 mgjdl (0.6 and 1.2 mg/dl for adults over age 65). A normal BUN level for an adult ranges between 4 and 22 mg/dl (8 and 18 mgjdl for adults over age 65). Elevations in your patient’s serum creatinine and BUN levels require further testing before a physician can make a diagnosis of diabetic nephropathy

Nursing Considerations

Test results are more accurate if your patient fasts for 8 hours beforehand; therefore, try to schedule the test for first thing in the morning, so that most of the fasting time will occur while she is sleeping. Tell her not to eat breakfast.

If your patient is taking ascorbic acid, a barbiturate, or a diuretic, her physician will probably withhold it until after the test because these drugs can raise serum creatinine levels. Note whether your patient is receiving amphotericin B, an aminoglycoside, methicillin, or chloramphenicol. Any of these nephrotoxic drugs could be the source of her renal impairment.

After drawing the blood, send the sample to the laboratory immediately. To prevent hemolysis, which can alter the test results, handle the blood sample gently.

If the BUN level is elevated but the serum creatinine level isn’t, consider possible extrarenal causes before repeating the tests. Also, keep in mind that the amount of creatinine produced in the body is related to muscle mass. Therefore, an athlete with normal renal function may have elevated levels of serum creatinine.

If your patient’s serum creatinine and BUN levels are both high, check them frequently to monitor her renal function. Abnormal renal function coupled with diabetes places your patient at increased risk for endstage renal disease and cardiovascular disease. The frequency of these tests depends on how high the patient’s serum creatinine and BUN levels are and whether she exhibits other signs.

A dietitian adapts a nutritional plan for an elderly patient with diabetes based on her special needs caused by aging. For instance, the poor vision that typically accompanies old age can affect a patient’s nutritional status by making it hard for her to read food labels or blood glucose meter results. Also, decreased mobility commonly affects a person’s ability to buy and prepare food. And declining mental status may make it difficult for your patient to plan and prepare meals or even remember to eat (or whether she has eaten).Many older people have limited finances, so they may not purchase a wide variety of fresh foods. They often eat irregularly, skipping meals or eating on a random schedule. A declining sense of taste and poor dentition affect nutrition by making mealtimes seem less pleasurable and more trouble than they’re worth. Other elderly people may have a chronic disease, such as kidney or cardiac disease, that increases the challenge of developing a nutritional plan.

Many elderly people take several drugs at the same time, increasing the risk of food-drug and drug-drug interactions, which may affect appetite, taste, and the ability to digest, absorb, metabolize, and excrete nutrients.

Meals delivered to a patient’s home may improve mealtime regularity and food variety. But as with meals served in long-term care facilities, home-delivered meals may limit the patient’s control over food choices and meal timing. A meal plan that concentrates on eating meals at the same time every day and eating foods that provide good nutrition may be the best way to overcome the obstacles faced by elderly patients.