EDUCATIONAL POINTS FOR DIABETES

1. EDUCATIONAL POINTS
FOR DIABETICS
SAIF ULLAH KHAN D14E123

2. DIABETES MELLITUS
• “Elevated blood glucose level resulting from defects in insulin
secretion, cells do not respond to insulin or both.”

5. DIABETES AND ITS CLASSIFICATION
• Type 1diabetes /IDDM
• Type 2 Diabetes /NIDDM
• Gestational diabetes mellitus
• Diabetes mellitus associated with other conditions or syndrome

6.  Self-Monitoring Blood Glucose (SMBG)
 Continuous Glucose Monitoring System (CGMS)
 Glycated Hemoglobin(HbA1c)
 Urine Glucose Testing
 Testing for Ketones

7. HbA1c mmol/mol %
Normal Below 42 mmol/mol Below 6.0%
Prediabetes 42 to 47 mmol/mol 6.0% to 6.4%
Diabetes 48 mmol/mol or over 6.5% or over

9. Insulin Type Onset of
action
Peak of
action
Duration of
action
Lispro
(Humalog®)
Rapid acting 5-15 minutes 1-2 hours 4-5 hours
NPH Intermediate
acting
1-2 hours 5-7 hours 13-18 hours

10. Insulin use
• demonstrates appropriate injection technique.
• Insulin should usually be injected before meals or after meal
• You will be told when to inject your doses, as different types of insulins are given at different times in
relation to food. It is important that you inject your doses as you have been advised.
• Some types of insulin require mixing before you withdraw a dose. This is done by rolling the bottle
slowly between your hands or by tipping the bottle upside down and then gently rotating it. Do not
shake insulin because it will froth or bubbles will form in the liquid and this will cause you to measure
an incorrect dose.
• Inject in the abdomen, the upper arms, thigh.
• Always check blood sugar before injecting insulin.
• If blood glucose is low, eat first, recheck, then inject if sugar has come up to normal.

12. Can insulin cause problems?
• Hypoglycaemia
• There may be some lumpiness at the site of the injection but regularly
changing the area of skin that you inject will help to prevent this.
• hypokalemia

13. How to store insulin
• Keep all medicines out of the reach and sight of children.
• Store unopened insulin in a refrigerator until you are ready to use it. Do not
freeze insulin.
• Once your insulin is in use you can keep it for a few weeks at room
temperature, as long as you keep it below 25°C and away from direct heat
and sunlight. Check the label for details of how long it can be kept
unrefrigerated and do not use it after this time.

14. GENERAL INSULIN DOSING
• Multiple daily doses or continuous subcutaneous infusions guided by blood
glucose monitoring are the standard of diabetes care. Combinations of
insulin formulations are commonly used. The daily doses presented below
are expressed as the total units/kg/day of all insulin formulations
combined.
• Initial total insulin dose: 0.2 to 0.6 units/kg/day in divided doses.
Conservative initial doses of 0.2 to 0.4 units/kg/day are often recommended
to avoid the potential for hypoglycemia. A rapid-acting insulin may be the
only insulin formulation used initially.

15. • Usual maintenance range: 0.5 to 1 units/kg/day in divided doses. An estimate of
anticipated needs may be based on body weight and/or activity factors as follows:
• Nonobese: 0.4 to 0.6 units/kg/day
• Obese: 0.8 to 1.2 units/kg/day
• Pubescent Children and Adolescents: During puberty, requirements may substantially
increase to >1 unit/kg/day and in some cases up to 2 units/kg/day (IDF-ISPAD, 2011).
• Adjustment of dose: Dosage must be titrated to achieve glucose control and avoid
hypoglycemia. Adjust dose to maintain premeal and bedtime glucose in target range.
Since combinations of agents are frequently used, dosage adjustment must address the
individual component of the insulin regimen which most directly influences the blood
glucose value in question, based on the known onset and duration of the insulin
component. Treatment and monitoring regimens must be individualized. Also see
Additional Information or Pharmacotherapy Pearls.

16. Cartridge insulin pen

17. Blood Glucose Testing
• How to use patient’s specific glucometer: demonstrate competency in use.
• When to test? Useful times: before injecting insulin, 1st thing in the morning,
1-2 hours after meals (Once per day is usually enough for patients not on
insulin unless otherwise ordered by provider).
• Blood Glucose Testing What is a “good” glucose level: 1) 80-120 before
meals, 2) 100-180 after meals. Visual.

20. The importance of exercise
• Exercise lowers your blood sugar for the whole day.
• Thirty minutes a day is great but EVERY LITTLE BIT HELPS. The
importance of exercise Ways to get some exercise include: walking (inside or
out), dancing, chair exercises, taking the stairs 1-2 flights, parking far from
store door, meeting a friend for coffee and walking around the block before
or after the coffee.

22. Diet: Food to limit
• Avoid sugar sodas.Switch to diet soda or water with lemon & sugar
substitute.
• Limit fruit juice to 4 oz. (1/2 cup) at a time : juice has as much sugar as soda.
• Watch portions of Rice, Pasta, Breads
• Limit fat intake, switch to canola or olive oil, limit fried foods
• Limit consumption of red meat, more poultry but remove skin

23. Diet: Food to increase
• Eat more vegetables, half plate. Discuss what patients think of as vegetables.
Remind them that corn and beans are high in carbohydrates (sugar)
• 3 fruits per day
• Snacks: sugar free jello; tea/coffee with couple gingersnaps or vanilla wafers,
fruit, sugar-free low fat yogurt, ½ sugar free pudding made with skim milk
(Visual)

24. • Inspect your feet every day
• Wash your feet every day
Small injury leads to skin ulcer so
protect your feet from any type of
injury

25. • https://www.drugs.com/ppa/insulin-lispro.html
• https://en.wikipedia.org/wiki/Insulin
REFERENCES