Diabetes and Thyroid In-Service 12-04


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Diabetes and Thyroid In-Service 12-04

  1. 1. Diabetes and thyroid disease in-service Alliance Care December 2004 The endocrine system (glands) controls many functions of the body. The glands include pituitary, thyroid, parathyroid, pancreas, adrenal glands, and the ovaries or testes. Each gland secretes a special hormone that sends messages to the bodies organs to do their jobs. We will explore diabetes and thyroid problems in this in-service, DIABETES- Glucose is the fuel used to run all the cells in your body. Starches and sugars are converted to glucose so that the body is able to use it. Insulin is the hormone released by the pancreas to control the level of glucose in the blood, the body is unable to use or store insulin without insulin. Insulin is released when blood glucose levels are high, usually after you have eaten. Insulin allows some glucose into the cells where it is used as energy. Excess glucose is stored in fat and muscle cells and the liver. A healthy body keeps blood glucose levels under control, when this system breaks down the result is high levels of glucose in the blood and the person is considered to have diabetes. There are two types of diabetes Type 1 or insulin dependent diabetes mellitus ( IDDM) and Type 2 or non insulin dependent diabetes mellitus (NIDDM). Type 1 diabetes- Type 1 diabetes occurs when the pancreas does not make insulin to control blood glucose levels. These patients require insulin injections every day to keep their glucose levels in balance. Type 1 diabetes is usually diagnosed before age 30, diabetes diagnosed in children or teens is Type 1 diabetes. 5-10% of all diabetes is type 1 diabetes. Symptoms usually come on rapidly with the client complaining of excessive thirst, excessive urination and weight loss. Untreated, diabetes can lead to death. Type 2 diabetes- Type 2 diabetes occurs when the cells become resistant to insulin, requiring more insulin to convert the same amount of glucose to energy. Type 2 diabetes is common in adults over 30 and accounts for 90% of all diabetes. Many people with type 2 diabetes are able to control their blood sugar with diet, exercise and weight control. Some may need to take oral medication to control their glucose levels and maybe insulin.
  2. 2. Pg2 Risk factors for type 2 diabetes: 1. age 40 or over 2. overweight 3. African American, Hispanic or American Indian 4. family history of diabetes 5. Gestational Diabetes (diabetes during pregnancy) Gestational diabetes- Occurs only during pregnancy and is a risk factor for developing type 2 diabetes later in life. Symptoms of Diabetes: 1. increased thirst 2. increased appetite 3. frequent urination 4. unexplained weight loss 5. fatigue or tiredness 6. frequent skin infections and slow healing of wounds 7. recurrent yeast infections or vaginitis 8. impotence 9. blurred vision 10. tingling or numbness in hands and feet Complications of diabetes: 1. atherosclerosis or hardening of the arteries, high blood pressure and heart disease 2. stroke 3. visual problems and blindness 4. slow healing of wounds and injuries 5. poor healing of wounds and injuries to feet due to impaired circulation 6. kidney or renal failure 7. damage to the nerves which reduces feeling in extremities which means that minor injuries may not be felt and not care for 8. intestinal problems due to impaired nerves in the digestive system
  3. 3. Pg 3 Keys to Treatment and Control of Diabetes Have a Plan to: 1. lose weight 2. exercise 3. learn about your medications 4. follow a healthy diet with diabetic considerations 5. have less stress 6. stop smoking You do not have to everything at once, pick one or two things to change at a time until you are following a healthy lifestyle that will help you manage your disease. Diabetic foot care- Foot care is essential for diabetics, diabetes impairs nerve function and an injury to the feet may not be noticed until it is a serious problem. Due to poor feeling and circulation to the feet, it is easy for small wounds to become infected and difficult to treat and to heal. Untreated infections can go to the bones causing a serious infection of the entire limb, requiring hospitalization and ultimately amputation of the limb and even death. Always notify the office of any wound on a diabetic client, they should also see a doctor for treatment ASAP. Foot Care: 1. Wash feet daily with mild soap and water and dry thoroughly 2. Inspect feet for cuts cracking wounds or peeling skin and report it ASAP. Dry carefully between toes. 3. Avoid strong soaps, Epsom Salts and Iodine 4. Do not use razors, corn removers or home remedies 5. File nails to prevent ingrown toe nails- NEVER CUT NAILS 6. See a podiatrist on a regular basis 7. Wear white cotton socks 8. Break in new shoes slowly and inspect for blisters 9. Do not walk bare foot use slippers in the house 10. Do not smoke 11. Use lanolin based lotion or other moisturizers to keep skin soft. Do not leave lotion between toes which can cause excess moisture to be trapped there casing problems. 12. Elevate feet while sitting. 13. Use caution with wheelchairs, keep feet on pedals with shoes or slippers on to avoid injury. Be careful on door jams etc. while wheeling patient around.
  4. 4. Pg 4 Eye Care- Diabetes can be very damaging to the eye and eyesight, regular follow up by an eye doctor is needed to prevent problems that lead to blindness. The most common problem is Diabetic Retinopathy, which damages the retina in the eye, there are often no symptoms until the disease is very advanced. Retinopathy can be easily diagnosed with an eye exam and a plan for treatment implemented before serious damage can occur. Untreated diabetic retinopathy will lead to loss of sight or blindness. Exercise- A regular exercise plan will help keep glucose levels under control. Increased exercise may also result in decreased need for insulin or diabetic medications because the cells will use more glucose. The exercise program should be developed with the doctor. The client may also have nerve damage that needs to be considered when choosing an exercise plan. Education- Diabetes education is available from dietitians and visiting nurses, support or education groups are also available at many hospitals. Also ask about local support groups that are made up people who have diabetes and professional personnel. Blood Glucose Monitoring- There are several types of glucose monitors available, the client or family will know how to operate their testing machine. The client or family must perform the finger stick with a needle to obtain blood for the testing machine. You may be trained to use the glucose monitor but you may not stick the client to obtain blood for the test. The client or family must also inject insulin, you may not perform the injection. There should be a sharps container or heavy duty plastic bottle like a bleach bottle that needles or sharps are collected in after testing or injecting insulin. The client or family member should put the needle directly into the sharps container you should not handle the needle or recap the needle. Needle should never be placed directly into the trash, if the client insists on placing needles into the trash you should not handle the trash and notify the office so that we may intervene with the family. Always carry trash away from your body, do not put your hands or feet into the trash can. If you are stuck with a needle call the office right away so that you may receive medical treatment and testing. The client will have a log or notebook to record blood glucose readings, you may assist with logging of the information needed. Always be aware of needles in the home, the client may stick them in upholstered furniture or leave them in the bed or on furniture or counters. BE AWARE, DO NOT BE STUCK.
  5. 5. Pg5 Medications for Diabetes- Type 1 diabetes is treated with insulin injections. Type 2 diabetes is treated with diet or oral hypoglycemic medications. In either case too much medication will make the blood sugar too low and too little medication will result in a high blood sugar level. Medication dosage is affected by exercise and illness and may need to be adjusted accordingly by the doctor. Reasons for Diabetics to call the doctor- 1. Changes in the regular pattern of blood glucose readings 2. Continued low blood sugar symptoms 3. A change in mental status – confusion, agitation- sleepiness 4. Wounds that will not heal 5. Any wound on the feet- blisters, fungus, ingrown toenails red areas that persist- 6. Lack of feeling or numbness the feet and/or hands 7. Vaginal yeast infections 8. Urinary infections 9. any infection of the respiratory tract DIABETIC EMERGENCIES: Hypoglycemia- Hypoglycemia is low blood sugar or blood glucose level, glucose monitor blood levels will be under 60. Onset can be very rapid and it is usually reversed by ingesting sugar. You may put sugar directly under the clients tongue or give orange juice or sugar sweetened soda with added sugar. Do not give an unconscious person anything to eat or drink. Untreated hypoglycemia may result in death. Symptoms of Hypoglycemia: 1. Sleepiness, weakness lethargy 2. Hunger 3. Nausea 4. profuse sweating 5. blurred or double vision 6. rapid heart rate 7. confusion, drunken like state 8. unconsciousness- Hypoglycemic Shock What do I do? Call 911, if the person is awake, give them something with sugar.
  6. 6. Pg 6 Hyperglycemia- Hyperglycemia is high blood sugar or blood glucose. The onset is more gradual maybe over several days. Blood glucose levels are usually over 300. Untreated Hyperglycemia will result in diabetic coma and death. Symptoms of Hyperglycemia: 1. Frequent urination 2. poor vision 3. dry hot skin 4. severe thirst 5. fast breathing may be shallow 6. fruity smell to breath ( ketoacidosis ) What should I do? Call 911, if the person is awake and you are unsure about the reason for the diabetic emergency give them sugar. Giving sugar will do no further harm to the patient and may reverse hypoglycemia. Be sure that you call 911 in either case as both hypo and hyperglycemia can result in death if not treated. Diabetic diets- Diet for diabetics is based on calorie restriction for carbohydrates and saturated fats. Whole grains and complex carbohydrates are lower in sugar and should be the included in the diet. Choosing whole wheat bread instead of white bread and brown rice instead of white rice will help control blood glucose. Low sugar choices and sugar free foods are also helpful. Since diabetics are very prone to heart disease a low fat and low salt diet is also indicated. Many diabetics follow a diet planned by the doctor or nutritionist and you should also follow that plan. The meal planning guidelines below are generalized for diabetics with type one and type two diabetes. Following a healthy diet will also control weight which is a big factor in type 2 diabetes. Meal planning guidelines for diabetics 1. Each meal should consist of a balance of carbohydrates, proteins and fats a. carbohydrates should include fruits starches and vegetables, with an emphasis on whole grains, b. lean protein selections should be made, cut off excess fats from meats with 10% of the total calories coming from saturated fat. 2. Meals should be served at consistent times of the day a. avoid skipping meals b. use measuring cups or a scale to weigh food portions
  7. 7. Pg 7 c. the client should eat within 30 minutes of taking insulin d. know portion size, a copy of the food pyramid is available at the office 3. Eat whole grains and increase both soluble and insoluble fiber, a. reads labels and choose high fiber foods to increase both insoluble and soluble fiber in the diet b. eat fresh fruit instead of juice c. pick whole grains 4. Avoid salt a. Use seasonings without salt and salt substitutes when possible b. Processed foods have more salt or sodium than fresh or non processed c. Avoid foods that have salt or sodium in the first few ingredients d. Look for low salt canned goods like soups and veggies e. Use high sodium condiments sparingly – ketchup, soy sauce, gravy mix, chicken broth or look for low salt versions 5. Prepare food in a healthful manner a. broil or bake instead of frying b. trim fats from meats and discard c. Eat veggies raw or steamed to retain fiber. d. Avoid using heavy fatty sauces and butter e. Use salt substitutes and other seasonings 6. Eat more frequent smaller meals or healthy snacks between meals a. smaller more frequent meals may enhance blood glucose control b. unplanned activity or illness may call for additional calories or a snack if blood glucose is low. c. be sure to spread calories over the day and not eat too much at one time 7. Use alcohol in moderation a. always consume alcohol with food to avoid hypoglycemia b. do not skip a balanced meal in exchange for alcohol c. limit alcohol to 1-2 drinks a week 8. Avoid free sugar in diet a. Use alternative sweeteners b. Limit the intake of diet sodas c. Avoid foods and drinks with concentrated sucrose or sugar or honey d. Use sugar free jello and pudding etc as part of the diet 9. Always have sugar available with the client when leaving home a. Hard candy or sugar packets can be taken along on outings for diabetic emergencies, there are also special diabetic bars available to carry along that will help with hypoglycemia. After taking sugar the client should eat some protein to prevent recurrence of hypoglycemia.
  8. 8. Pg 8 THYROID PROBLEMS- Many older people develop thyroid problems requiring medications to keep the thyroid levels in the normal range. The thyroid gland is located in the front of the neck, it releases hormones to make the body run properly. If the thyroid is not functioning properly it may release too much or too little thyroid hormone. Too much thyroid hormone results in hyperthyroidism and too little results in hypothyroidism. Hyperthyroidism is also called Graves’s disease. Symptoms of Hyperthyroidism: 1. Weight loss with increased food intake 2. heat intolerance 3. shortness of breath 4. loose stools 5. night sweats 6. red itchy eyes and bulging eyes 7. weakness in the lower extremities 8. anxiety, hyperactivity When to call the doctor: 1. Fever 2. increased weakness or lethargy 3. profuse sweating 4. severe restlessness and agitation 5. pounding heart rate Symptoms of Hypothyroidism: 1. lethargy, sleepiness 2. constipation 3. swelling around the thyroid also called a Goiter 4. swelling of the face and tongue 5. change in voice or hoarseness 6. slow heart rate 7. poor reflexes 8. poor endurance When to call the doctor: 1. extreme intolerance of the cold, more than usual 2. severe sleepiness or lethargy 3. difficulty breathing with swelling of the face or throat 4. constipation lasting more than 2 days without a bowel movement 5. unusual confusion