Nursing care module for diabetic care

1. Diabetic Care Module
Comprehensive Training Presentation
(Introduction & Pathophysiology Sample)

2. What is Diabetes?
Chronic metabolic disorder characterized by hyperglycemia
Results from defects in insulin secretion, insulin action, or both

3. Types of Diabetes
Type 1 Diabetes – autoimmune destruction of beta cells
Type 2 Diabetes – insulin resistance + beta-cell dysfunction
Gestational Diabetes – during pregnancy
Other types – secondary to diseases/medications

4. Global Burden
537 million adults (20–79 yrs) living with diabetes worldwide (IDF 2021)
Expected to rise to 643 million by 2030
Major cause of morbidity, mortality, and healthcare cost

5. Why Diabetic Care Matters
Prevent acute complications (DKA, HHS, hypoglycemia)
Reduce risk of chronic complications (CVD, kidney disease, blindness, amputations)
Improve quality of life and longevity

6. Objectives of Module
Understand pathophysiology, diagnosis, and management
Emphasize lifestyle interventions and self-care
Highlight acute and chronic complication management
Empower healthcare teams and patients

7. Normal Glucose Metabolism
Insulin regulates glucose uptake in muscle and adipose tissue
Suppresses hepatic glucose production
Maintains normal fasting and postprandial glucose levels

8. Pathophysiology of Type 1 Diabetes
Autoimmune destruction of pancreatic beta cells
Absolute insulin deficiency
Often presents in childhood/adolescence

9. Pathophysiology of Type 2 Diabetes
Combination of insulin resistance and impaired beta-cell function
Progressive loss of insulin secretion over time
Associated with obesity, sedentary lifestyle, genetics

10. From Prediabetes to Diabetes
Insulin resistance develops early
Beta-cell dysfunction worsens gradually
Impaired glucose tolerance progresses to overt diabetes

11. Consequences of Hyperglycemia
Acute: DKA, HHS
Chronic: Microvascular (retinopathy, nephropathy, neuropathy)
Chronic: Macrovascular (CVD, stroke, PAD)

12. Pathophysiology Flowchart
Progression from genetic and environmental risk factors to diabetes complications.

13. Diagnostic Criteria
Fasting Plasma Glucose (FPG) ≥ 126 mg/dL (7.0 mmol/L)
2-hour OGTT ≥ 200 mg/dL (11.1 mmol/L)
HbA1c ≥ 6.5%
Random plasma glucose ≥ 200 mg/dL with symptoms

14. Screening Guidelines
Adults ≥ 45 years: test every 3 years
Younger adults with risk factors: overweight, family history, hypertension, PCOS
Gestational diabetes screening at 24–28 weeks

15. Monitoring Methods
Self-Monitoring of Blood Glucose (SMBG) using glucometers
Continuous Glucose Monitoring (CGM) for real-time trends
HbA1c every 3–6 months
Urine tests for protein/ketones when needed

16. Target Goals
HbA1c: < 7% (individualized)
Preprandial plasma glucose: 80–130 mg/dL
Postprandial plasma glucose: < 180 mg/dL
Blood pressure: < 130/80 mmHg

17. Diagnosis Algorithm
Step 1: Screen risk factors / symptoms
Step 2: Order FPG, OGTT, or HbA1c
Step 3: Confirm abnormal test on repeat day
Step 4: Diagnose diabetes or prediabetes
Step 5: Initiate lifestyle/pharmacological care

18. Importance of Monitoring
Detects disease early
Prevents acute complications
Slows chronic complications
Guides therapy adjustment

19. HbA1c Diagnostic Ranges
Normal: <5.7%
Prediabetes: 5.7–6.4%
Diabetes: ≥6.5%

20. Role of Diet
Balanced meals with whole grains, vegetables, lean protein
Limit refined carbs and sugary beverages
Encourage portion control and mindful eating

21. Glycemic Index
Low GI foods: legumes, oats, whole grains
High GI foods: white bread, sugary snacks
Prefer low-to-moderate GI meals to reduce glucose spikes

22. Physical Activity
At least 150 min/week of moderate-intensity aerobic activity
Strength training 2–3 times/week
Reduce sedentary time (break sitting every 30 min)

23. Weight Management
Aim for 5–10% weight loss in overweight patients
Sustainable lifestyle changes over crash diets
Behavioral counseling may help

24. Stress Management
Stress increases cortisol → raises blood sugar
Techniques: yoga, meditation, breathing exercises
Support groups and counseling

25. Sleep & Circadian Rhythm
Poor sleep linked to insulin resistance
Target 7–8 hours of quality sleep
Maintain regular sleep-wake schedule

26. Alcohol & Smoking
Limit alcohol: ≤1 drink/day (women), ≤2 drinks/day (men)
Avoid binge drinking → risk of hypoglycemia
Smoking cessation is critical to reduce CV risk

27. Personalized Care
Cultural dietary considerations
Individualized exercise capacity
Tailored goals for elderly or comorbid patients

28. Lifestyle Management Wheel
Comprehensive approach to optimize glycemic control.

29. Pharmacological Management Overview
Drug therapy complements lifestyle management
Goal: achieve individualized glycemic targets
Choice depends on age, comorbidities, cost, patient preference

30. Oral Agents: Metformin
First-line therapy unless contraindicated
Mechanism: reduces hepatic glucose production, improves sensitivity
Side effects: GI upset, rare lactic acidosis
Contraindicated in severe renal/hepatic impairment

31. Oral Agents: Sulfonylureas
Examples: glibenclamide, glipizide
Mechanism: increase insulin secretion
Advantages: inexpensive, effective
Risks: hypoglycemia, weight gain

32. Oral Agents: DPP-4 Inhibitors
Examples: sitagliptin, saxagliptin
Mechanism: increase incretin levels → more insulin, less glucagon
Well tolerated, weight neutral
Costlier option

33. Oral Agents: SGLT2 Inhibitors
Examples: dapagliflozin, empagliflozin
Mechanism: increase urinary glucose excretion
Benefits: weight loss, ↓CV risk, ↓CKD progression
Risks: genital infections, dehydration, ketoacidosis

34. Injectable Agents: GLP-1 RAs
Examples: liraglutide, semaglutide
Mechanism: enhance insulin, suppress glucagon, slow gastric emptying
Benefits: weight loss, CV protection
Side effects: nausea, GI upset, high cost

35. Insulin Therapy
Indicated when oral therapy inadequate or in severe hyperglycemia
Types: basal, prandial, premixed
Requires patient education on injection, hypoglycemia prevention

36. Insulin Regimens
Basal-only: once daily (NPH, glargine, detemir)
Basal-bolus: basal + mealtime rapid-acting
Premixed: fixed ratio of basal + bolus
Choice depends on patient lifestyle and glucose pattern

37. Treatment Algorithm
Step 1: Lifestyle + Metformin
Step 2: Add 2nd agent (SGLT2i, DPP4i, SU, or GLP1-RA)
Step 3: Triple therapy if needed
Step 4: Insulin initiation when HbA1c uncontrolled

38. Key Considerations
Individualize therapy by comorbidities (CVD, CKD, obesity)
Balance efficacy, safety, cost, and adherence
Educate patients on hypoglycemia recognition and sick-day rules

39. Acute Complications Overview
Diabetes can cause sudden life-threatening events
Most common: Hypoglycemia, DKA, HHS
Prompt recognition and treatment is critical

40. Hypoglycemia
Definition: blood glucose <70 mg/dL
Symptoms: sweating, tremors, confusion, seizures
Treatment: oral glucose, IV dextrose, glucagon if severe
Prevention: patient education, medication adjustment

41. Diabetic Ketoacidosis (DKA)
More common in Type 1 DM
Causes: infection, missed insulin, MI
Features: hyperglycemia, acidosis, ketonuria
Treatment: fluids, IV insulin, electrolytes, treat cause

42. Hyperosmolar Hyperglycemic State (HHS)
Occurs mainly in Type 2 DM, elderly
Very high glucose (>600 mg/dL), dehydration, no significant ketosis
Treatment: aggressive IV fluids, insulin, correct electrolytes

43. Acute Complication Management Flowchart
Algorithm for rapid recognition and treatment of acute diabetic emergencies.

44. Chronic Complications Overview
Long-term hyperglycemia damages vessels and organs
Microvascular: eyes, kidneys, nerves
Macrovascular: heart, brain, peripheral arteries

45. Microvascular: Retinopathy
Leading cause of blindness
Types: non-proliferative, proliferative, macular edema
Screening: annual eye exam
Treatment: laser, anti-VEGF therapy

46. Microvascular: Nephropathy
Leading cause of ESRD
Signs: proteinuria, declining GFR
Prevention: tight BP and glucose control, ACE inhibitors/ARBs
Annual urine albumin/creatinine ratio

47. Microvascular: Neuropathy
Peripheral: numbness, pain, ulcers
Autonomic: gastroparesis, ED, orthostatic hypotension
Screen: foot exam annually
Prevention: glucose control, foot care

48. Macrovascular: Cardiovascular Disease
Increased risk of MI, stroke, PAD
Risk factors: hypertension, dyslipidemia, smoking
Prevention: BP <130/80, statins, aspirin if indicated
Lifestyle + pharmacological management

49. Complication Prevention Strategies
Tight glucose control
Annual screening: eyes, kidneys, feet
Manage BP and lipids
Smoking cessation, exercise, healthy diet

50. Chronic Complication Burden
Distribution of long-term complications in diabetes.

51. Special Populations Overview
Management must be tailored for different groups
Gestational diabetes, elderly patients, children/adolescents
Consider unique risks, comorbidities, and lifestyle factors

52. Gestational Diabetes: Screening & Risks
Screen at 24–28 weeks with OGTT
Risks: macrosomia, neonatal hypoglycemia, maternal type 2 DM later
Close monitoring required during pregnancy

53. Gestational Diabetes: Management
Lifestyle modification: diet and exercise
Insulin is preferred if medication needed
Oral agents (metformin, glyburide) used selectively
Frequent glucose monitoring essential

54. Elderly Patients
Higher risk of hypoglycemia and comorbidities
Individualized HbA1c targets (often <8%)
Polypharmacy and drug interactions common
Focus on quality of life and fall prevention

55. Children & Adolescents
Most Type 1, some Type 2 (with obesity)
Insulin is mainstay; pump/CGM use increasing
Challenges: growth, puberty, peer/social issues
School/daycare support needed

56. Self-Care & Patient Education
Cornerstone of effective diabetes management
Includes glucose monitoring, medication adherence, diet, exercise
Patient empowerment and shared decision-making critical

57. Self-Monitoring of Blood Glucose (SMBG)
Frequency depends on therapy (more with insulin)
CGM improves control and reduces hypoglycemia
Patients must learn to interpret and act on results

58. Foot Care
Daily self-inspection of feet
Annual professional exam
Prevent ulcers and amputations
Wear proper footwear, avoid barefoot walking

59. Sick-Day Rules
Monitor glucose and ketones more frequently
Continue insulin even if eating less
Maintain hydration
Seek medical care if vomiting or unable to control glucose

60. Empowerment & Support
Diabetes self-management education (DSME) programs
Support groups improve adherence
Technology (apps, reminders) aids daily care
Family/caregiver involvement beneficial

61. Self-Management Cycle
Ongoing process of monitoring, adapting lifestyle/medications, and reassessing control.

62. Innovations in Diabetes Care
Technology and research improving outcomes
New medications, devices, and digital tools
Patient-centered, personalized approaches

63. Continuous Glucose Monitoring (CGM)
Provides real-time glucose trends
Reduces hypoglycemia risk
Improves HbA1c control
Increasingly accessible for Type 1 and Type 2 patients

64. Insulin Pumps & Closed-Loop Systems
Insulin pumps deliver continuous basal insulin
Closed-loop (artificial pancreas) automates insulin delivery
Improves control and quality of life
Still costly but adoption growing

65. New Drug Classes
SGLT2 inhibitors: renal and CV benefits
GLP-1 receptor agonists: weight loss and CV protection
Dual GIP/GLP-1 agonists under research
Precision medicine tailoring drugs to patient profile

66. Digital Health & Apps
Mobile apps for monitoring and reminders
Telemedicine improves access
Wearables track activity, glucose, heart rate
Empower patients for self-care

67. Future Directions
Stem cell therapy for beta-cell regeneration
Advances in islet transplantation
Gene editing potential for Type 1 diabetes
Artificial intelligence for predictive care

68. Summary of Key Points
Diabetes requires lifelong care and monitoring
Lifestyle + pharmacological management crucial
Preventing complications saves lives and costs
Education and empowerment improve adherence
Technology and innovation are transforming care

69. Key Takeaways
Individualize care for each patient
Integrate lifestyle, medication, and monitoring
Screen and prevent acute/chronic complications
Leverage new technology for better outcomes
Support patients with education and empathy

70. Closing Thoughts
Diabetes care is a team effort
Healthcare providers, patients, and families must collaborate
Goal: longer, healthier, and complication-free life for people with diabetes

71. Thank You!
Questions & Discussion