With professional help, individuals with diabetes can learn to practice good self-care skills that reduce the risk of long-term complications.
Without insulin, glucose accumulates in the bloodstream.
Type 1 diabetes tends to develop rapidly and is more severe and instable than other forms of diabetes.
The onset of type 1 diabetes occurs rapidly among children and adolescents.
Name some examples of medications used to treat type 2 DM.
Ask students to describe a typical person at risk for developing type 2 DM.
Women with gestational diabetes are taught to follow a careful diet and monitor blood glucose, blood pressure, and urinary protein.
List types of drugs and chemicals that cause secondary diabetes.
What are some underlying conditions that are often present with impaired glucose tolerance? (Hypercholesterolemia, obesity, hypertension)
Explain how an accurate nursing assessment and health history assist in identifying patients at risk.
Define the normal range for laboratory test results.
Diabetes was traditionally considered a disease of carbohydrate metabolism, but it actually involves all three of the energy-yielding nutrients: carbohydrate, fat, and protein.
Case Study:Mr. Jones is a 45-year-old black male. He is 25 lbs overweight. He also has a family history of diabetes. His most recent lab work reveals an elevated fasting blood sugar, elevated total cholesterol, and low HDL level.
Risk factors for diabetes include:Family history of diabetesOverweightRaceElevated fasting blood sugarElevated lipid levels
Additional screening tools for diabetes include:Glucose tolerance testGlucose in the urineA1C
Increased thirstIncreased urinationIncreased hungerUnusual weight loss (type 1)Unusual weight gain (type 2)
The backup source of glycogen stored in the liver and muscles is constantly turned over.
What are the islets of Langerhans? (Specialized cells located in the pancreas)
Islets of Langerhans, located in the pancreas.
Which pancreatic cells produce insulin? (Beta cells)
Which pancreatic cells produce glucagon? (Alpha cells)
Describe how all three hormones relate to one another.Where in the pancreas is somatostatin produced? (Delta cells)
These are the three macronutrients.
Insulin normally attaches to insulin receptor sites on cells throughout the body and assists in the migration of glucose into the cells.
An excess of ketones in the body results in diabetic ketoacidosis.
The loss of protein causes weight loss, muscle weakness, urinary nitrogen loss.
The long-term complications of diabetes result from hyperglycemia, which causes microvascular and macrovascular dysfunction in major organs.
List complications associated with uncontrolled diabetes.
The importance of self-care has led to a new emphasis on education that encourages more self-care responsibility.
Pregnancy presents a special challenge to women with diabetes because they must meet the increased physiologic demands of pregnancy while battling the manifestations of diabetes.
Glycemic control is the primary focus in diabetes management.
A plan for medical nutrition therapy must take into consideration the individual’s personal and cultural food preferences.
Discuss the importance of glycemic control before, during, and after exercise.
See the inside cover of the text for DRIs for children and adults; make appropriate adjustments for overweight adults.
The diet for a person with diabetes is always based on the normal nutrition needs for that person.
Are sugar substitutes allowed if a patient has diabetes? (Yes, in moderation. Caloric sweeteners should be accounted for in the meal.)
A goal of proper food distribution is to prevent extreme high and low blood glucose levels.
Diet planning should consider school and work activities, sports, social events, and stressful activities.
Individuals should consume additional carbohydrates during exercise as needed to prevent hypoglycemia.
Blood glucose monitoring results will dictate the changes to food distribution, medications, and exercise.
Why must individual preferences and cultural background be taken into consideration? (The diet must be palatable to the individual and must make use of foods known to the cultural group.)
Both dietitians and people with diabetes use the food exchange system to meet the patient’s energy and nutrient needs.
People with diabetes must time their insulin doses when eating out to coincide with food arrival.
The ultimate goal of DSME is to improve health status and quality of life.
People with diabetes will be more likely to make healthy food choices when they understand that how to food plan helps them maintain good blood glucose control.
For individuals at risk for type 2 diabetes or with prediabetes: Decrease risk of diabetes and cardiovascular diseasePromote healthy food choices and physical activity Maintain moderate weight lossIndividuals with diabetesAchieve and maintain:Blood glucose levels as safely as possibleLipid and lipoprotein profile Blood pressure levelsPrevent, or at least slow, the rate of chronic complications Address individual nutrition needs Maintain the pleasure of eatingNutrition therapyTotal energy balanceNutrient balanceFood distribution balancePersonal dietTotal kilocalories of energy balanceRatio of carbohydrate, fat, proteinDaily food distribution pattern
Other resources include certified diabetes educators, hospital and clinic dietitians, dietitians in private practice, public health nutritionists, and local chapters of the American Diabetes Association.
Patients and health care providers can use the American Association of Diabetes Educator’s Web site to locate a specialist.