Type II Diabetes Mellitus

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 Diagnostics Possible Procedures Patient Preparation Symptoms Medications

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

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 higherThis 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 http://www.youtube.com/watch?v=LduOMevISDw&feature=feedwll&list=WL

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).

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)

23. Renal Failure

24. Retinopathy – eyes

25. Blurred vision

26. Cataracts

27. Glaucoma

28. Blindness

29. Diffuse Neuropathies

30. Focal Neuropathies

32. Risk factor assessmentPhysical 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

36. retinopathy, cataracts, glaucoma and macular edema.

37. If not treated these problems can lead to vision loss or complete blindness.

39. 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

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 Periodontitis Gingivitis

42. Complications Skin ulceration, Charcot joint Neuropathy

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 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

47. nausea

48. hunger

49. tiredness

50. perspiration

51. headache

52. heart palpitations

53. numbness around the mouth

54. tingling in the fingers

55. tremors

56. muscle weakness

57. blurred vision

58. cold temperature

59. excessive yawning

60. Irritability

61. loss of consciousnessInformation source http://www.medicinenet.com/insulin/page2.htm

62. 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.

63. 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

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.

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.

74. http://www.dietitian.com/calcbody.php

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 healthVideo links - in-depth information http://digital.films.com/PortalPlaylists.aspx?aid=11739&xtid=8920 http://digital.films.com/PortalViewVideo.aspx?xtid=43644&loid=

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

82. Getting involved in group sports or inviting friends to join is great encouragement for staying active.

84. 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.

85. Webb References http://diabet-control.blogspot.com/2009/01/diagnosis-and-screening-test-diabetes.html http://drkupe.blogspot.com/2011/03/diabetes-type-2.html http://www.webmd.com/hypertension-high-blood-pressure/guide/high-blood-pressure http://www.diabetes.org/living-with-diabetes/complications/high-blood-pressure-hypertension.html http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm http://www.nei.nih.gov/health/diabetic/retinopathy.asp http://www.diabetesselfmanagement.com/Articles/Eyes-And-Vision/what_to_expect_at_your_eye_exam/ http://www.diabetes.org/living-with-diabetes/complications/foot-care.html http://www.lifeclinic.com/focus/diabetes/foot_prevent.asp http://www.neuropathy-treatment.org/tag/diabetic-neuropathy http://www.keyvive.com/diabetic-community/wiki/diabetes-lab-tests/

86. 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

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