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Diabetes Part 1
 

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