Diabetes Part 1
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Diabetes Part 1 Diabetes Part 1 Presentation Transcript

  • Care of Clients with Diabetes Mellitus
    1
    Part 1 - Basics
  • ADA Guidelines for Diagnosis
    Normal serum glucose: 70-110
    Diabetes
    FBS > 126 on 2 occasions
    Random glucose > 200 with symptoms
    Pre-diabetes
    FBS > 100
    Random glucose 140- 200
    2
  • Type 1 Diabetes
    Autoimmune reaction in which beta cells that produce insulin are destroyed
    Genetic predisposition: HLA linkage
    Environmental triggers can stimulate an autoimmune response
    Viral infections: mumps, rubella, coxsackievirus
    3
  • Treatment Type 1 Diabetes
    Diet
    Exercise
    Insulin
    Monitoring
    4
  • Type 2 Diabetes- Etiology
    Insulin resistance
    Decreased production of insulin by beta cells
    Liver releases too much glucose
    Genetics
    http://www.diabetes.org
    5
  • Type 2 Diabetes- symptoms
    Few symptoms initially
    Fatigue
    Altered vision
    Nocturia
    Skin infections, vaginal infections, poor wound healing
    6
  • Type 2 Diabetes Risk Factors
    Obesity
    Family history
    Over age 45
    High-risk ethnic group: African, Native American, Hispanic
    Delivery of baby > 9 pounds
    History of: gestational diabetes, polycystic ovary syndrome
    Hypertension
    7
  • Type 2 diabeteschildren & adolescents
    Incidence on the rise
    No symptoms in early stage of disease
    Symptoms: frequent infections, weight loss with increased appetite, blurry vision, polyuria, bed wetting
    8
  • Acanthosis nigricans
    Area of darkened skin & velvety thickening on the child’s neck, armpits, groin, or other areas of skin folds.
    Sign of insulin resistance
    Found in 90% of children with type 2
    Most often seen in African American & Hispanics
    9
  • Acanthosis nigricans
    10
  • Type 2 diabetes in children
    Prevention: Exercise 1 hr/day, healthy diet
    Test high risk groups age 10 years or more every 2 years
    Overweight
    Family history
    Hispanic, African American, Asian American
    11
  • Treatment Type 2 Diabetes
    Diet
    Monitoring blood glucose
    Exercise
    Oral Medication
    Insulin
    12
  • Gestational diabetes
    Last half of pregnancy placenta produces insulin antagonist
    (human placental lactogen)
    Leads to increased placental destruction of insulin
    Insulin production needs to increase 2-3 X non- pregnant level
    13
  • Gestational Diabetes: Diagnosis
    1 hour glucose challenge test using a 50 gram oral glucose if results > 140 mg/dl will have to retest with:
    3 hour glucose tolerance test using 100 gram oral glucose: diagnosis confirmed when any 2 or more glucose values are over 140 mg/dl
    14
  • Gestational Diabetes: Treatment
    Blood glucose self-monitoring
    Diet
    Exercise
    Stress management
    Pharmacologic therapy: insulin
    15
  • Gestational diabetes- effects on infant
    Macrosomia- 9.9 lbs or >
    Hypoglycemia- for first 72 hours of life
    Infant accustomed to increase in glucose which leads to hyperinsulinemia in the infant. At birth the glucose supply from mother is no longer present but infants pancreas continues to produce large amounts of insulin.
    16
  • Gestational Diabetes
    No longer have diabetes after delivery of infant
    Women with gestational diabetes have up to a 45% risk of recurrence with next pregnancy and up to 63% risk of developing type 2 diabetes later in life
    17
  • Diet
    Food Guide Pyramid
    www.mypyramid.gov
    Carbohydrate Counting
    15 gm CHO= 1 exchange
    45-60 grams per meal
    Plate Method
    Exchange List
    18
  • Diet education
    Initially should be done by dietitian
    Never skip meals if on oral sulfonylureas
    Learn to recognize food portions
    Alcohol suppresses liver production of sugar
    19
  • Diet Education
    Remember:
    No foods are forbidden for people with diabetes
    It’s not carbs the patient should worry about
    It’s the amount of carbs consumed
    Portion control !!!!
    20
  • Carbohydrate
    Healthy carbs come from fruit, veggies, whole grains, legumes and low-fat milk
    Need to monitor intake and divide throughout the day
    Sugar is allowed within reason
    Fiber is recommended
    21
  • Food Labels
    Locate serving size
    Locate total grams of carbohydrate
    15 g = 1 carb choice
    Ignore sugar grams
    22
    X
  • Exercise
    Regular
    Consistent
    Aerobic: 30 min/day most days
    Resistance training: 2-3 times/week
    Type 1- increases insulin sensitivity
    Type 2- wt loss, decrease insulin resistance
    23
  • Self-Monitoring of Blood Glucose(SMBG)
    Modern meters
    Small blood volume (0.3 to 4 L)
    Ability to use alternate sites
    Shorter results time: 5 to 10 seconds
    Very accurate if maintained properly
    24
  • Monitoring Glycemic Control
    A1C formerly know as Hgb A1C
    Blood test measuring glycosylated Hgb A
    Glycosylation: glucose binds irreversibly to Hgb
    A1C reflects mean glucose level past 2-3 months
    Check every 3-6 months
    Normal < 6%
    Goal for diabetic < 7%
    25
  • Targets for Glucose ControlType 1 and Type 2 Diabetes
    70-130 mg/dL
    <180 mg/dL
    100-140 mg/dL
     7%
    Fasting/Pre-meal glucose
    Post-meal glucose
    2 hr. after start of meal
    Bedtime glucose
    A1C
    26
  • A1C and blood sugar results
    27
  • Insulin Therapy
    Type 1- always required
    Type 2- during periods of stress, illness, surgery and when all other treatments fail
    28
  • Insulin
    36% with type 2 diabetes use insulin
    within 5 years of diagnosis 50% require
    Weight gain can be significant: 5-10 kg 1st yr
    Insulin dose needed varies
    Most serious side effect is hypoglycemia
    29
  • Terms describing time & effect of insulin
    Onset: time span after administration when insulin will begin to effect the blood glucose level
    Peak: time span after administration when the insulin will have the greatest effect on the blood glucose level
    Duration: time span after administration when insulin will continue to effect the blood glucose level
    30
  • Basal & Bolus
    Basal Insulin: insulin required to suppress hepatic glucose production between meals
    Bolus Insulin: insulin required to maintain normal glucose disposal after meals
    Normal process of pancreas in healthy person
    31
  • Storage of Insulin
    Open vial at room temperature 30 days
    No direct sunlight
    Do not store in freezer
    Keep out of glove compartment
    Extra vial in door of refrigerator
    32
  • Mixing Insulin
    Always draw up clear first to prevent contamination of fast acting insulin
    Can be pre-drawn and stored in refrigerator for 1 week
    Store needle upright & agitate syringe before administering
    33
  • 34
    Box 18.3 Mixing insulin (Figures only)
  • Sliding Scale
    Used with intensive insulin therapy and during hospitalization to maintain euglycemia
    Accu-check should be no more than ½ hour prior to the administration of the corrective insulin dose
    35
  • Sites for injection
    Abdomen
    Back of arm
    Middle anterior thigh
    Upper buttocks
    36
  • Rotation of sites
    Insulin injections should be given in the same region at a specific time of day & rotated within that region
    Due to difference in absorption rates of sites
    37
  • Insulin devises
    Insulin pump- receives rapid acting insulin continuously per subcutaneous route
    Insulin pen- good for visually impaired and people with problems with dexterity
    38
  • Insulin Pumps
    39
  • Insulin Pump site
  • Insulin Pump: During hospitalization
    Have physician write orders to leave the pump in place
    Don’t discontinue the pump unless insulin therapy is given IV or subcutaneously
    41
  • Insulin Pump: During hospitalization
    Patient should change their site every 2-3 days
    and
    Whenever blood glucose is over
    240 mg/dl for 2 tests in a row
    42
  • Oral Antihyperglycemic Agentsfor Type 2 Diabetes
    43
    Class
    Sulfonylureas
    Biguanides
    Thiazolidinediones
    Meglitinides
    α-Glucosidase inhibitors
    DPP-4 Inhibitors