TYPE II - Diabetes Mellitus Through out this presentation you will find website and video links that can be opened to obtain more details on the topic if further information is desired. Double click on a link open or video to play.
Section II Key Labs Diagnostics Possible Procedures Patient Preparation Symptoms Medications
Key Labs for Diabetes Testing FBS – Fasting Blood Sugar (glucose) levels GTT – Glucose Tolerance Test PPBS – 2Hr. Post-Prandial Blood Sugar HbA1C – Hemoglobin Average Amount of glucose in a 2-3 month period. Lipid profile HDL, cholesterol, LDL, triglyceridesare recommended also
FBS The FBS – Fasting Blood Sugar or Fasting Plasma Glucose (FPG) test is the standard test for diagnosing diabetes. It is a simple blood test taken after 8-10 hours of fasting. In general, results indicate the following FPG levels are considered normal up to 100 mg/dL (or 5.5 mmol/L). Levels between 100 and 125 mg/dL (5.5 to 7.0 mmol/L) are referred to as impaired fasting glucose or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications. Diabetes is diagnosed when FPG levels are 126 mg/dL (7.0 mmol/L) or higher. Might be ordered to help diagnose diabetes. Blood Glucose (BC) can be measured after 8-10 hours of fasting
GTT - To determine if blood glucose level are in healthy ranges; to screen for, diagnose, and monitor hyperglycemia, hypoglycemia, diabetes, and pre-diabetes
A fasting glucose is collected; then the patient drinks a customary amount of a glucose solution to "challenge" their system. This is followed by one or more additional glucose tests performed at specific intervals to track glucose levels over time.
OGTT - Test OGTTThe oral glucose tolerance test is used to diagnose diabetes. The first portion of the test involves drinking a special glucose solution. Blood is then taken several hours later to test for the level of glucose in the blood. Patients who have diabetes will have higher than normal levels of glucose in their blood. The OGTT may be ordered to help diagnose diabetes and as a follow-up test to an elevated blood glucose
OGTT levels are normal up to 140 mg/dL
Levels between 140 mg/dL and 199 mg/dL are referred to as impaired glucose tolerance or pre-diabetes
Diabetes is diagnosed when OGTT levels are 200 mg/dL or higher
This test is often used for Gestational Diabetes Mellitus
FBG - Recommendations The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes, or if the tests are normal in people who have symptoms or risk factors for diabetes. For example, people who take the test in the afternoon and show normal results may actually have abnormal levels that would be revealed if they are tested in the morning. The oral glucose tolerance test (OGTT)is more complex than the FPG and may over diagnose diabetes in people who do not have it. Some experts recommend it as a follow-up after FPG, if the latter test results are normal but the patient has symptoms or risk factors of diabetes.
Differences FBC & OGTT TestClick Screen to Start Video (duration - 1:01) clicking elsewhere will end the video follow the link at bottom of page incase the video dose not open http://www.youtube.com/watch?v=LduOMevISDw&feature=feedwll&list=WL
UGTT- Urine Glucose Tolerance Test is used to test renal functions can be used at home
The kidney begins to excrete sugar in the urine when the blood sugar reaches 150g 180 mg/dl.
Monitoring Glucose Levels PPBS – “two-hour post-prandial blood sugar test (2-h PPBS) test blood sugar two hours after consuming a meal. This test is used to monitor blood glucose levels after meals PPBS –Pre-Prandial Blood Sugar Before meals This test is used to monitor blood glucose levels prior to eating http://www.youtube.com/watch?v=qUCUa99pW8Q
HbA1C HbA IC - measures the concentration of glycated (also often called glycosylated) hemoglobin A1c. Hemoglobin is an oxygen-transporting protein found inside red blood cells (RBCs). There are several types of normal hemoglobin and many identified hemoglobin variants, but the predominant form – about 95-98% – is hemoglobin A. Hemoglobin A can be further subdivided, with one of the subcomponents known as hemoglobin A1c. As glucose circulates in the blood, some of it spontaneously binds to hemoglobin A. The glucose-hemoglobin molecules formed are said to be glycated. The higher the concentration of glucose in the blood, the more glycated hemoglobin is formed. Once the glucose binds to the hemoglobin, it remains there for the life of the red blood cell - normally about 120 days. The combination of glucose and hemoglobin A is referred to as HbA1c or A1c. A1c is produced on a daily basis and slowly cleared from the blood as older RBCs die and younger RBCs (with non-glycated hemoglobin) take their place (A1c and EAG).”
HbA1C cont. “Hemoglobin A1C and eAG calculation used to monitor the glucose control of diabetics over time. The goal of those with diabetes is to keep their blood glucose levels as close to normal as possible. This helps to minimize the complications caused by chronically elevated glucose levels, such as progressive damage to body organs like the kidneys, eyes, cardiovascular system, and nerves. The A1c test and eAG result give a picture of the average amount of glucose in the blood over the last few months. They can help the doctor know if the measures being taking to control diabetes are successful or need to be adjusted (A1c and EAG).” “A1c is frequently used to help newly diagnosed diabetics determine how elevated their uncontrolled blood glucose levels have been. It may be ordered several times while control is being achieved, and then several times a year to verify that good control is being maintained (A1c and EAG).
Hemoglobin A1c(HbA1c) Analyzer More Details on A1C Test
HbA1C Video link if video dose not open (3.03) http://www.youtube.com/watch?v=6bRhV2u2op0&feature=related
Open this link for details about A1C Analyzers (6:01)
Key Diagnosticsrelated to possible complication of uncontrolled diabetes The patient has been diagnosed with Type II Diabetes. Uncontrolled Type II diabetes can become Type I making the patient insulin dependent Annual Reviews are needed Macrovascular complications
Physical examination Laboratory Lifestyle Examinations Two measurements of blood pressure, lying or sitting. Assessment for vascular bruits Heart murmur, Status of feet (including presence and quality of peripheral pulses) Calculation of the ankle/brachial index. Complete Medical History
Prevention Regulate Glucose Regular Check ups Diagnosing and Treating Diabetes Video
Dental Checkups Diabetes causes higher risk of: Tooth decay (cavities). The mouth contains many types of bacteria. Starches and sugars in food and beverages interact with these bacteria, forming a sticky film called plaque. The acids in plaque attacks teeth’s enamel leading to cavities. Early gum disease (gingivitis). Diabetes reduces the bodies ability to fight bacteria, causing more plaque to build up on teeth. If the plaque is not removed with regular brushing and flossing, it'll harden under the gum line into what is known as tartar (calculus). The longer plaque and tartar remain on the teeth, the more they irritate the gingiva In time, the gums become swollen and bleed easily which is gingivitis. Advanced gum disease (periodontitis). Left untreated, gingivitis lead s to a more serious infection called periodontitis, which destroys the soft tissue and bone that support the teeth. Eventually, periodontitis causes the gums to pull away from the teeth till they loosen and even fall out. Periodontitis tends to be more severe among people who have diabetes. Diabetes lowers the ability to resist infection and slows healing. An infection such as periodontitis may also cause a spike in blood sugar levels, making the diabetes more difficult to control. Preventing and treating periodontitis helps improve blood sugar control.
Eye Exam Patient needs to see an Optometrist so they can keep an eye on the eyes
Eye problems that are common in patience with diabetes include
retinopathy, cataracts, glaucoma and macular edema.
If not treated these problems can lead to vision loss or complete blindness.
Sometimes there are no symptoms for these complications and can only be identified by a doctor.
Podiatrist Patient should visit a Podiatrist - diabetes can lead to many problems with the feet. Including foot sores Foot ulcers Foot amputation Foot pain Peripheral vascular disease. Daily foot care is important & Annual Visits to the Podiatrist The Doctor should test for: sensation in the feet foot structure pulses in the feet skin on the feet joint or balance problems calluses, redness, swelling, or warmth
Complications Uncontrolled Diabetes Leads to: Heart Disease Stroke Blindness Kidney failure Painful peripheral nerve damage Amputations Sweet Breath - Ketosis Acanthosis Nigricans Dark skin tags Encourage patients to: Report unusual sensations, numbness or pain Report digestive, urinary or sexual problems Avoid injury to areas with decreased sensation Take medications as directed Inspect feet daily & practice good foot care
Diabetic Neuropathy Diabetic neuropathy is a type of nerve damage that can occurs diabetes. High blood sugar can injure nerve fibers throughout the body, most often damaging nerves in the legs and feet. Depending on the affected nerves, symptoms range from pain to numbness in extremities to problems with the digestive system, urinary tract, blood vessels and heart. For some symptoms are mild; for others painful, disabling even fatal. Tight blood sugar control and a healthy lifestyle is the best way to prevent or slow the progress of Diabetic neuropathy’s and their serious complications.
Information on foot care http://www.youtube.com/watch?v=_RkxiYJKZyE
Type II Diabetes Symptoms Common Frequent Urination Unexplained Weight Loss Extreme Thirst/Dry Mouth Headaches Frequent Hunger Lack of energy Some times no symptoms will be present Could include Slow healing of wounds Itchy skin Yeast infections Weight gain Skin Changes Neck, Arm pit, Groin Numbness/Tingling of hands or feet Decreased Vision
Oral Medications Oral Medications Side Effects Sulfonylureas. These diabetes pills lower blood sugar by stimulating the pancreas to release more insulin Biguanides. These diabetes pills improve insulin's ability to move sugar into cells especially into the muscle cells. They also prevent the liver from releasing stored sugar. Thiazolidinediones. These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of sugar released by the liver and make fat cells more sensitive to the effects of insulin Alpha-glucosidase inhibitors, including Precose (acarbose) and Glyset (miglitol). These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%. Meglitinides, including Prandin (repaglinide) and Starlix (nateglinide). These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. Dipeptidyl peptidase IV (DPP-IV) inhibitors, including Januvia (sitagliptin) and Onglyza (saxagliptin). The DPP-IV inhibitors work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. Combination therapy. There are several combination diabetes pills that combine two medications into one tablet. Side effects of first- and second-generation sulfonylureas include: Hypoglycemia (low blood sugar) Upset stomach Skin rash or itching Weight gain Side effects for biguanide medications include: Upset stomach (nausea, diarrhea) Metallic taste in mouth Side effects for thiazolidinediones are rare but may include: Elevated liver enzymes Liver failure Respiratory infection Headache Fluid retention Side effects for alpha-glucosidase inhibitors include: Stomach upset (gas, diarrhea, nausea, cramps) Side effects of meglitinides include: Hypoglycemia (low blood sugar) Stomach upset Information Source http://diabetes.webmd.com/guide/oral-medicine-pills-treat-diabetes?page=2
Medications Insulin SIDEEFFECTS A natural hormone made by the pancreas controlling the glucose levels in the blood. Insulin permits cells to use glucose for energy. Cells cannot utilize glucose without insulin. Hypoglycemia is the most common side effect with insulin therapy. Symptoms Include
Information source http://www.medicinenet.com/insulin/page2.htm
Lente – Humulin NPH Lente Lente (Humulin) is a human-made form of insulin the hormone produced naturally by the pancreas. Lente is an intermediate-acting insulin that starts working about 1.5 hours after it is injected Lente, improve A1C levels using insulin but are not achieving A1C goals Pramlintide injections taken with meals have been shown to modestly improve A1C levels without causing increased hypoglycemia or weight gain and even promote modest weight loss. Humulin® L, Novolin®L Lente insulin help patients meet basal insulin requirements between meals and overnight, fast acting onset peaks in 4-8 hours after injections stays in the system for 13 – 20 hours can be used once or twice a day (Berkowitz, 2002)”. Caution it can give nocturnal hypoglycemia when given at bedtime. Humulin, the trade name for human insulin made by Eli Lilly, there are various trade names available for this produce. Humulincomes in many preparations: NPH, Lente, UltraLente, Regular, 70/30, and others. NPH, (Neutral protamine hagedorn) onset 2-4 should be taken after food peaks in 4-12 hours, last 16-20 hours used in newly diagnosed diabetes, given subcutaneously as part of multi-dose regimen of short- and long-acting insulin.
Insulin Training Video 1 Duration 6:15 ** Video 2 Duration 9:46 Link to 1st video (6:15) if it fails to start http://www.youtube.com/watch?v=d4J2Ifex1ak&feature=related Link to video 2nd (9:46) if it fails to start http://www.youtube.com/watch?v=SA7yCKxzzr0&feature=related
Patient Training for Monitoring Glucose Levels
Patients on insulin should record their glucose levels with a glucometer 4 times a day according to Doctor recommendations.
Video links - in-depth information http://digital.films.com/PortalPlaylists.aspx?aid=11739&xtid=8920 http://digital.films.com/PortalViewVideo.aspx?xtid=43644&loid=
Diet Details Vegetables provide vitamins, fiber and minerals. Vegetables are low in carbohydrate. Eat raw and cooked vegetables with little or no fat or steamed vegetables, Fewer vitamins are lost when veggies are steamed Eat raw or cooked fruits canned in their own juices preferably. Avoid those canned in syrup. Eat fruit rather than drinking fruit. Save high-sugar and high-fat fruit desserts for special occasions. (Limited amounts) Choose skim or low fat 1% dairy products & yogurts that are sweetened with a low-calorie sweetener. Choose cuts of meat that have little fat on them. Trim off all excess fat when cooking. Remove the skin from chicken and turkey broil, grill, roast, steam, microwaving or stir-fry. Opt for sugar-free desserts, limit the consumption of artificial sweeteners eat fruit for a sweet snack instead When eating out order small or child-sized servings or share desserts . To avoid overeating measure food consumed.
Daily Exercise Thirty minutes a day of moderate exercise is often enough to effect positive change Walking - Jogging Moderate Weight lifting Cycling – Jumping Rope
Finding enjoyable activates will increases the odds of continuing.
Getting involved in group sports or inviting friends to join is great encouragement for staying active.
Warming up prior to exercise and stretching after will help prevent injuries
Actives to Avoid
Cited Sources "A1c and EAG." Lab Tests Online: Welcome! American Association for Clinical Chemistry, 6 Feb. 2009. Web. 01 June 2011. <http://www.labtestsonline.org/>. Berkowitz, K. (2002, August). Lantus? or Lente? The American Journal of Nursing, 8. Core Team, JQuery UI. "MEDS." Privacy Is an Occupation, Not a Choice... 2011. Web. 01 June 2011. <http://www.cputeknology.com/diabetesdocs.htm>. Dea, Tara L. "Pediatric Obesity Type 2 Diabetes." The American Journal of Maternal/Child Nursing 31.1 (2011): 42-48. Print. Department of Women and Infant Nursing OB/GYN Clinic,. (2009). Fasting Blood Sugar and Two Hour after Eating (Post-Prandial) Blood Sugar Test. Ohio: The Ohio State University Medical Center. Luna , B., & Feinglos, M. N. (2001, May 1). Oral Agents in Management of Type 2 Diabetes Mellitus. American Famliy Physician, 1747-1757. Freeland, Barbara S. "Using Human Insulin." American Journal of Nursing 98.3 (1998): 16. Print. "Glucose." Lab Tests Online: Welcome! American Association for Clinical Chemistry, 22 Mar. 2011. Web. 01 June 2011. <http://www.labtestsonline.org>. Manzella R.N, D. (2008, July 5). Oral Medications for Managing Type 2 Diabetes. About Guide.com. McCarron, K., & Riebel, T. (2008, September/October). Spotlight on type 2 Diabetes. Nursing made incrediabley easy, 44-54. McCarron, K., & Riebel, T. (n.d.). Understanding Type II Diabetes.
You Tube Videos Animated Type 2 Diabetes - http://www.youtube.com/watch?v=KYoV3RxwFD8&NR=1 Type 2 Diabetes - http://www.youtube.com/watch?v=KYoV3RxwFD8&feature=related Diabetes Patient Education Types of insulin - http://www.youtube.com/watch?v=SA7yCKxzzr0&feature=related How type 2 develops - http://www.youtube.com/watch?v=fe8uuc8m118&feature=related Insulin Education - http://www.youtube.com/watch?v=d4J2Ifex1ak&feature=related Diabetes Mellitus type 2 explanation - http://www.youtube.com/watch?v=y3l-rfxY_Ew&feature=related What is Type 2 Diabetes? - http://www.youtube.com/watch?v=nBJN7DH83HA&feature=related Diabetes Mellitus - http://www.youtube.com/watch?v=VLiTbb6MaEU&feature=related Diabetes Overview - http://www.youtube.com/watch?v=sTgBvJsHcCk Insulin Resistance - http://www.youtube.com/watch?v=YXFJWoHura8&feature=related Insulin, Glucose and You Lantus -http://www.youtube.com/user/WhyInsulin?v=_w7u6ZzlaFc&feature=pyv&ad=11398906891&kw=diabetes TYPE II (sugar diabetes) - http://www.youtube.com/watch?v=kZz5utFLhYQ&feature=related BNN Type-2 Diabetes - http://www.youtube.com/watch?v=j5rtJ4I3K2E&feature=related Type 2 Diabetes - http://www.youtube.com/watch?v=ZsTSoLhl3Y4&NR=1&feature=fvwp Information on foot care http://www.youtube.com/watch?v=_RkxiYJKZyE Pre-prandial - http://www.youtube.com/watch?v=qUCUa99pW8Q
Click Screen to Start Video ~ There are several video’s explaining Type II Diabetes to see selection of all three click on the box next to the play button on the bottom left corner once the video appears. Click on the video choice to pay Total Running Time of all is 9min 29 sec