Lecture 11: Diabetes & Self-Management

‭Pathophysiology‬ ‭‬ G ● ‭ lucose/energy: Primarily from food‬ ‭●‬ ‭Pancreas: Large gland that secretes chemical‬ ‭substances; digestive and endocrine organ‬ ‭○‬ ‭Insulin and glucagon‬ ‭●‬ ‭Insulin‬ ‭●‬ ‭Glucagon‬ ‭Insulin‬ ‭‬ A ● ‭ hormone secreted by beta cells of the pancreas‬ ‭●‬ ‭Move glucose into cells, reducing serum levels‬ ‭Type 1 Diabetes‬ ‭‬ B ● ‭ eta cells produce little-no insulin‬ ‭●‬ ‭Juvenile diabetes; insulin-dependent diabetes‬ ‭○‬ ‭Mostly affects children/adolescents‬ ‭●‬ ‭Autoimmune disease against beta cells‬ ‭●‬ ‭No signal to take glucose in from the blood‬ ‭Type 2 Diabetes‬ ‭ ‬ I‭ nsulin deficiency: Pancreas not producing enough insulin‬ ● ‭●‬ ‭Insulin resistance: Fat, liver, and muscle cells do not use insulin properly‬ ‭○‬ ‭Receptor doesn’t receive signal to take in glucose from blood‬ ‭ uestion:‬‭A nurse is teaching students about the characteristics of DM1. Which of the following‬ Q ‭describes the underlying cause of the disease?‬ ‭a.‬ ‭Atrophy of pancreatic alpha cells‬ ‭b.‬ ‭Destruction of pancreatic beta cells‬ ‭c.‬ ‭Cellular resistance to insulin‬ ‭d.‬ ‭Increased hepatic glycogenesis‬ ‭ uestion:‬‭Which type of diabetes is controlled primarily‬‭through diet, exercise, and oral‬ Q ‭antidiabetic agents?‬ ‭a.‬ ‭Type 1 diabetes‬ ‭b.‬ ‭Type 2 diabetes‬ ‭Glucagon‬ ‭‬ A ● ‭ hormone produced by alpha cells‬ ‭●‬ ‭Stimulates the liver to convert glycogen (stored in the liver/muscles) to glucose‬ ‭○‬ ‭Secreted when hypoglycemic‬ ‭●‬ ‭Converts amino acids into glucose (gluconeogenesis)‬ ‭●‬ ‭Breaks down stored fat (triglycerides) into fatty acids for use as fuel by cells‬ ‭●‬ ‭Medication: Forms of glucagon-like insulin medication‬ ‭ uestion:‬‭Prior to discharge, the nurse performs teaching‬‭for a patient admitted with a new‬ Q ‭diagnosis of DM1. The patient asks for more information about the purpose of glucagon. Which‬ ‭is the best response from the nurse?‬ ‭a.‬ ‭Glucagon increases your cell’s sensitivity to insulin when you’re hyperglycemic.‬ ‭b.‬ ‭You take glucagon if you’ve had too much insulin or are severely hypoglycemic.‬ ‭c.‬ ‭Glucagon will keep your blood sugar from spiking throughout the day.‬ ‭d.‬ ‭You should use glucagon only when your blood sugar is above 150 mg/dL.‬ ‭Ranges of Blood Glucose‬ ‭‬ N ● ‭ ormally, after meals: 70-120 mg/dL‬ ‭●‬ ‭Hypoglycemia: BGL < 70 mg/dL‬ ‭○‬ ‭Monitor insulin treatment‬ ‭●‬ ‭Hyperglycemia: BGL > 120 mg/dL‬ ‭Diagnosing Diabetes‬ ‭Random Blood Sugar Test‬ ‭‬ A ● ‭ blood sample taken at a random time‬ ‭●‬ ‭Regardless of last meal, > 200 mg/dL indicates diabetes‬ ‭Fasting Plasma Glucose Test (FPG)‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ lood sample taken after an overnight fast‬ B ‭Diabetes: 126 mg/dL or greater‬ ‭Pre-diabetes: 125 mg/dL to 100 mg/dL‬ ‭Normal: Less than 100 mg/dL‬ ‭Hemoglobin A1C (HgbA1C) Test‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ he percentage of blood glucose attached to hemoglobin‬ T ‭Average blood glucose level for the past 2-3 months (how long Hgb lives)‬ ‭Normal: < 5.7%‬ ‭Prediabetes: 5.7-6.4%‬ ‭Diabetes: > 6.5%‬ ‭If A1C is consistently high, glucose gets stuck and damages blood vessels and nerves‬ ‭Oral Glucose Tolerance Test‬ ‭‬ A ● ‭ blood glucose level (BGL) measured after an overnight fast‬ ‭●‬ ‭The patient then drinks a sugary liquid (75 grams of glucose), and BGL is tested after 30‬ ‭minutes, 1 hour, 2 hours, and 3 hours‬ ‭●‬ ‭Fasting: 60-100 mg/dL‬ ‭●‬ ‭1 hour: < 200 mg/dL‬ ‭●‬ ‭2 hours: < 140 mg/dL, diabetes if > 200 mg/dL‬ ‭Checking Glucose‬ 1‭ .‬ S ‭ et out a glucometer, test strip, lancet, and alcohol prep pad‬ ‭2.‬ ‭Wash your hands to prevent infection‬ ‭3.‬ ‭Helps to warm hands first if self-checking to increase circulation‬ ‭a.‬ ‭Can rub hands together briskly or run them under warm water‬ ‭4.‬ ‭Check expiration date for a test strip‬ ‭5.‬ ‭Turn on the glucometer and place a test strip in the machine when ready‬ ‭6.‬ ‭Make sure the hand is dry and wipe with an alcohol pad; wait until the alcohol evaporates‬ ‭7.‬ ‭Pierce the fingertip on the soft, fleshy pad, wipe the first drop, then obtain the next‬ ‭8.‬ ‭Place the blood on/at the side of the strip‬ ‭9.‬ ‭The glucometer will take a few moments to calculate the blood sugar reading‬ ‭10.‬‭You may use the alcohol pad to blot the site where blood was drawn if still bleeding‬ ‭11.‬‭Document/write down results‬ ‭Question:‬‭Blood sugar is well controlled with hemoglobin‬‭A1C is…‬ ‭a.‬ ‭< 7%‬ ‭i.‬ ‭For diabetics; < 5.7% for nondiabetics‬ b‭ .‬ 1‭ 2-15%‬ ‭c.‬ ‭< 180 mg/dL‬ ‭d.‬ ‭90-130 mg/dL‬ ‭Complications‬ ‭Small Blood Vessel Damage‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ icrovascular complications‬ M ‭Increased glucose impairs circulation‬ ‭Blindness (retinopathy)‬ ‭Kidney disease (renal failure)‬ ‭Nerve Damage/Neuropathy‬ ‭‬ F ● ‭ eet and hands‬ ‭●‬ ‭Heart and circulation‬ ‭●‬ ‭Stomach, bladder, and sex organs‬ ‭Nursing Diagnoses‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ isk for unstable blood glucose‬ R ‭Deficient knowledge‬ ‭Risk for infection (bacterial affinity for sugar)‬ ‭Risk for disturbed sensory perception (vision)‬ ‭○‬ ‭May result in fall risk‬ ‭Sense of powerlessness‬ ‭Risk for ineffective therapeutic regimen management‬ ‭Risk for injury‬ ‭Imbalanced nutrition‬ ‭Risk for deficient fluid volume‬ ‭Fatigue‬ ‭Risk for impaired skin integrity‬ ‭Self-Management‬ ‭‬ M ● ‭ onitoring BGL‬ ‭●‬ ‭Taking medication‬ ‭●‬ ‭Following a meal plan‬ ‭○‬ ‭Consistency (especially for DM1, otherwise hard‬ ‭to control)‬ ‭●‬ ‭Getting regular exercise‬ ‭Foot Care‬ ‭‬ D ● ‭ ecreased perfusion; numbness and tingling lead to no sensory recognition‬ ‭●‬ ‭Inspect, wash, dry, and moisturize‬ ‭●‬ ‭Protect from heat and cold: Do not use a heating pad, hot water bottle, or electric blanket‬ ‭on the feet; be cautious of hot baths‬ ‭●‬ ‭Avoid walking barefoot‬ ‭●‬ ‭Never attempt to remove corns, calluses, warts, or other foot growths independently‬ ‭●‬ ‭Do not sit with legs crossed or stand in one position for long periods of time‬ ‭●‬ ‭Cut straight across nails rather than in a curved fashion to prevent ingrown toenails‬ ‭●‬ ‭Be careful not to cut toenails too short‬ ‭Safe Physical Activity‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ est BGL before and after activity, as it will be used during exercise‬ T ‭Always warm up and cool down‬ ‭Wear the right shoes and socks (not too tight)‬ ‭Drink enough water‬ ‭Wear or carry an ID (medical alert bracelet)‬ ‭Insulin Therapy‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ apid-acting insulin: Lispro (Humalog), aspart (Novolog)‬ R ‭Short-acting insulin: Regular insulin (Humulin R, Novolin R)‬ ‭Intermediate-acting insulin: NPH (Humulin N, Novolin N)‬ ‭Long-acting insulin: Glargine (Lantus)‬ ‭Onset‬ ‭Peak‬ ‭Duration‬ ‭Rapid‬ ‭15 m‬ ‭1 h‬ ‭3 h‬ ‭Short‬ ‭30 m‬ ‭2 h‬ ‭8 h‬ ‭Intermediate‬ ‭2 h‬ ‭8 h‬ ‭16 h‬ ‭Long‬ ‭2 h‬ ‭none‬ ‭24 h‬ ‭Hypoglycemia‬ ‭Symptoms‬ ‭‬ H ● ‭ eadache‬ ‭●‬ ‭Anxiety‬ ‭●‬ ‭Hunger‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ izziness‬ D ‭Impaired vision (seeing double)‬ ‭Tachycardia‬ ‭Shaking‬ ‭Irritability‬ ‭Weakness/fatigue‬ ‭Sweating‬ ‭Sleepiness‬ ‭Confusion‬ ‭Lack of coordination‬ ‭Seizures‬ ‭Unconsciousness‬ ‭Treatment/Management‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ at or drink 15 grams of fast-acting low-fat carbohydrates right away‬ E ‭½ cup fruit of orange, apple, or grapefruit juice‬ ‭½ cup regular soft drink (not diet)‬ ‭1 cup skim milk‬ ‭2 tbsp raisins‬ ‭6 crackers‬ ‭3-5 pieces hard candy‬ ‭1 piece bread‬ ‭3-4 glucose tablets or 1 tube glucose gel (if unconscious)‬ ‭11 jellybeans‬ ‭Hyperglycemia‬ ‭Symptoms‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ olyphagia‬‭(since glucose is in bloodstream, not cells)‬ P ‭Polydipsia‬‭(compensation for increased glucose)‬ ‭Polyuria‬ ‭Dry mouth‬ ‭Blurred vision‬ ‭Cardiac arrhythmias‬ ‭Stupor‬ ‭Seizures‬ ‭Coma‬ ‭ uestion:‬‭A client is taking Humulin NPH insulin daily‬‭every morning. The nurse instructs the‬ Q ‭client that the most likely time for a hypoglycemia reaction to occur is…‬ a‭ .‬ ‭b.‬ ‭c.‬ ‭d.‬ 2‭ -4 hours after admin‬ ‭4-12 hours after admin‬ ‭16-18 hours after admin‬ ‭18-24 hours after admin‬ ‭Serious Potential Complications‬ ‭‬ D ● ‭ iabetic ketoacidosis (DKA): Mostly in DM1‬ ‭●‬ ‭Hyperosmolar hyperglycemia state (HHS): Mostly in DM2‬ ‭Diabetic Ketoacidosis (DKA)‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ ccumulated glucose; not enough insulin made‬ A ‭Glucose is unable to enter cells for energy, so the body begins to break down fat‬ ‭Ketonuria: Ketones (waste products of fat) accumulate in excess circulation, then urine‬ ‭Life-threatening condition‬ ‭Causes‬ ‭●‬ ‭Missed insulin dose(s)‬ ‭●‬ ‭An underlying infection, dehydration, stress‬ ‭Symptoms‬ ‭●‬ ‭Hyperglycemia‬ ‭●‬ ‭Ketonuria‬ ‭●‬ ‭Polydipsia‬ ‭●‬ ‭Polyphagia‬ ‭●‬ ‭Polyuria‬ ‭●‬ ‭Dry mouth/skin‬ ‭●‬ ‭Fruity-smelling breath‬ ‭●‬ ‭N/V‬ ‭●‬ ‭Abdominal pain‬ ‭●‬ ‭Fatigue‬ ‭●‬ ‭Flushed face‬ ‭●‬ ‭Tachypnea‬ ‭●‬ ‭Confusion‬ ‭Treatment‬ ‭●‬ ‭Fluids: PO or IV; isotonic fluids are preferred‬ ‭●‬ ‭Insulin: Usually IV‬ ‭●‬ ‭Electrolytes: Replace those low due to too little insulin (ex. K, Na, Cl)‬ ‭○‬ ‭IV electrolytes help keep the heart, muscles, and nerve cells working properly‬ ‭●‬ ‭Medication: Treat any underlying illness, such as antibiotics for infection‬ ‭●‬ ‭Monitoring: For complications (ex. Effects on the brain, heart, or lungs)‬ ‭Hyperosmolar Hyperglycemic State‬ ‭‬ S ● ‭ erious complication often seen in people with DM2‬ ‭●‬ ‭Characterized by extremely high BGL without the significant presence of ketones‬ ‭Symptoms‬ ‭●‬ ‭Symptoms develop gradually‬ ‭●‬ ‭Very high BGL: Often above 600 mg/dL or 33.3 mol/L‬ ‭●‬ ‭Extreme thirst and dry mouth: Due to dehydration‬ ‭●‬ ‭Frequent urination: Body tries to rid excess glucose‬ ‭●‬ ‭Warm, dry skin: Lacks sweat, even if dehydrated‬ ‭●‬ ‭Fever: Not too high‬ ‭●‬ ‭Altered mental state: Ranging from confusion to hallucinations‬ ‭●‬ ‭Weakness or fatigue: Cells are unable to properly use glucose for energy‬ ‭●‬ ‭Blurred vision: High BGL affects the eyes‬ ‭●‬ ‭N/V: Less common than in DKA‬ ‭●‬ ‭Seizures: In severe cases due to electrolyte imbalances‬ ‭●‬ ‭Loss of consciousness/coma: Left untreated‬