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Rhenea lyle type ii - diabetes mellitus group presentation section 2 q. 5-8


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Type II Diabetes Mellitus

Type II Diabetes Mellitus

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  • (Department of Women and Infant Nursing OB/GYN Clinic, 2009).”
  • Transcript

    • 1. 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.
    • 2. Section II
      Key Labs
      Possible Procedures
      Patient Preparation
    • 3. 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
    • 4. 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
    • 5. GTT Test
      • GTT - To determine if blood glucose level are in healthy ranges; to screen for, diagnose, and monitor hyperglycemia, hypoglycemia, diabetes, and pre-diabetes
      • 6. 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
      • 7. Levels between 140 mg/dL and 199 mg/dL are referred to as impaired glucose tolerance or pre-diabetes
      • 8. Diabetes is diagnosed when OGTT levels are 200 mg/dL or higher
      This test is often used for Gestational Diabetes Mellitus
    • 9. 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.
    • 10. 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
    • 11. Lab Test - Renal Functions
      • UGTT- Urine Glucose Tolerance Test is used to test renal functions can be used at home
      • 12. 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
    • 13. 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).”
    • 14. 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).
    • 15. Hemoglobin A1c(HbA1c) Analyzer
      More Details on A1C Test
      • HbA1C Video link if video dose not open (3.03)
      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
      • Peripheral Arterial Disease (PAD)
      • 16. Pain and Discomfort w/walking
      • 17. Cerebrovascular Disease
      • 18. Hemorrhage - Strokes
      • 19. Cardiovascular Disease
      • 20. Coronary Artery Disease (CAD)
      • 21. Congestive Heart Failure (CHF)
      • 22. Hypertension (HTN)
      Microvascular complications
    • General Assessment
      Family history
      • Symptoms
      • 32. Risk factor assessment
      Physical examination
      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
    • 33. Prevention
      Regulate Glucose
      Regular Check ups
      Diagnosing and Treating Diabetes Video
      • 34.
    • 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.
    • 35. 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
      • 36. retinopathy, cataracts, glaucoma and macular edema.
      • 37. If not treated these problems can lead to vision loss or complete blindness.
      • 38. 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
    • 39. Complications
      Uncontrolled Diabetes Leads to:
      Heart Disease
      Kidney failure
      Painful peripheral nerve damage
      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
    • 40. 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.
    • 41. Complications
    • 42. Complications
      Skin ulceration, Charcot joint
    • 43. Complications
      Advanced Peripheral Neuropathy
      • Information on foot care
    • Type II Diabetes Symptoms
      Frequent Urination
      Unexplained Weight Loss
      Extreme Thirst/Dry Mouth
      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
    • 44. 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
      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
    • 45.
    • 46. Medications
      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
    • 62. Lente – Humulin NPH
      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.
    • 63. Insulin Training
      Video 1 Duration 6:15 ** Video 2 Duration 9:46
      Link to 1st video (6:15) if it fails to start
      Link to video 2nd (9:46) if it fails to start
    • 64. 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.
    • Patient Training for Monitoring Glucose Levels
      • Patients with satisfactory HbA1c levels should
      • 65. Test FBG once daily
      • 66. 1hr. post-prandial levels (after meals)
      • 67. Check monitor quarterly for quality control.
      • 68. Purchase a new monitors every two years.
      • 69. Bring personally recorded glucose data to the diabetic reviews.
    • Life Style Changes
      • The food pyramid can assist in making smart food choices.
      • 70. It divides food into groups, based nutritional continent.
      • 71. The pyramid is simple, eat more from the bottom and less from the top.
      • 72. Foods high in carbohydrates are located at the bottom.
      • 73. These foods affect blood sugar the most, selecting wisely.
    • Diabetic Dietitian & Educator Example only for the purpose of this project.
      • Healthy Body Calculator® (follow Link)
      • 74.
      • 75. Question and Answers from Dietitians
      Joanne Larsen MS RD LD -
      • 76. Diabetic Educators specializes in working with diabetic patience.
      • 77. Dietitian can be found at the American Dietetic Association.
      • 78. A healthy BMI is desired for optimal health
      Video links - in-depth information
    • 79. 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.
    • 80. Daily Exercise
      Thirty minutes a day of moderate exercise is often enough to effect positive change
      Walking - Jogging
      Moderate Weight lifting
      Cycling –
      Jumping Rope
    • 81. Stick to it
      • Finding enjoyable activates will increases the odds of continuing.
      • 82. Getting involved in group sports or inviting friends to join is great encouragement for staying active.
      • 83. Warming up prior to exercise and stretching after will help prevent injuries
    • Actives to Avoid
    • 84. Cited Sources
      "A1c and EAG." Lab Tests Online: Welcome! American Association for Clinical Chemistry, 6 Feb. 2009. Web. 01 June 2011. <>.
      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. <>.
      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. <>.
      Manzella R.N, D. (2008, July 5). Oral Medications for Managing Type 2 Diabetes. About
      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.
    • 85. Webb References
    • 86. You Tube Videos
      Animated Type 2 Diabetes -
      Type 2 Diabetes -
      Diabetes Patient Education Types of insulin -
      How type 2 develops -
      Insulin Education -
      Diabetes Mellitus type 2 explanation -
      What is Type 2 Diabetes? -
      Diabetes Mellitus -
      Diabetes Overview -
      Insulin Resistance -
      Insulin, Glucose and You Lantus -
      TYPE II (sugar diabetes) -
      BNN Type-2 Diabetes -
      Type 2 Diabetes -
      Information on foot care
      Pre-prandial -
    • 87. 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