Incidence of Diabetes

2. Incidence of Diabetes • 20.8 million in U.S. • 1 in every 400-600 children in U.S. have Diabetes • Most common in African American, Native American, Hispanic • Increases with age • Pre-diabetes- blood sugar is higher than normal, but not diabetic yet

4. Causes Cause is not fully understood; however, incidence is increase by: • Heredity • Obesity • Age • Diet • Lack of exercise

5. Nutrient Review What are the 6 nutrients???? When we eat we digest then absorb nutrients into our blood What nutrient is used for energy??? As our body breaks down the carbohydrates FOR energy, the carbs are actually broken down into starchesand sugar and then further into their simplest form known as glucose. Our pancreas secretes insulin so that the glucose molecules in our blood can be metabolized.

6. Key Terms Associated with Normal Metabolic Process • Starches and sugar- make up carbohydrates • Carbohydrates-nutrient that body uses for energy • Metabolism-process of breaking down food to be used as energy • Glucose-simplest form of carbohydrate metabolism • Pancreas-endocrine gland that secretes insulin • Insulin-hormone that regulates blood sugar levels • 80-120- normal blood sugar level in body

7. Normal Metabolic Process • When we eat our body uses carbohydrates (starches/sugar) for energy. Our body metabolizes carbohydrates by breaking them down into their simplest form known as glucose. Once levels of glucose (sugar) rise in the blood, our pancreas responds by secreting insulin. Insulin is a hormone that attaches to the glucose and actually allows our body to use it as it breaks it down. The insulin maintains the normal level of glucose (blood sugar) in our body at a level of 80-120. This is naturally done through homeostasis.

8. Normal Metabolic Process Review • What does the body normally use for energy? • What is the “simplest” form of carbohydrate metabolism? • What is the endocrine gland that secretes insulin? • What is the process of “breaking down” food/nutrients to be used as energy? • What is the hormone secreted by the pancreas to control blood sugar? • What is the normal blood sugar level in the body? • What are carbohydrates made up of?

9. What is diabetes? Diabetes is a SILENT, METABOLIC disease that can affect your eyes, nerves and kidneys over time. It is a CHRONIC disease of deficient carbohydrate metabolism due to lack of OR resistance to the effects of INSULIN.

10. Diabetes These problems with insulin cause the body to be unable to properly process or metabolize food into energy. The glucose from the food breakdown (carbohydrates—starches—simple sugars) remain in the bloodstream, resulting in persistent elevated blood sugar levels.

11. Key Terms Associated with Diabetes Metabolism- breaking down to use for energy Glucose- simple sugar Insulin-hormone secretes by pancreas that lowers glucose levels Pancreas-organ that produces insulin Carbohydrates-nutrient class used for energy Fats & Proteins-nextnutrient class used for energy Ketones-acid by products of fat metabolism Fluid & Electrolyte (F&E) Imbalance-when fluids and electrolytes (potassium, sodium) are imbalanced

12. Disease Pathology Cells do not “pick up” the glucose and metabolize it for energy because there is no insulin, not enough insulin, or the body is resistant to the insulin. Insulin allows the cells to use the glucose and metabolize it for energy.

13. Disease Pathology Because cells can’t metabolize or use the glucose, they have to get energy somewhere else, so they metabolize fats and proteins.

14. Disease Pathology The by-products, or end results of fat and protein metabolism causes ketones to build up in the blood. Ketones are acids that are NOT normally found in the body. The body tries desperately to get rid of these “acids” and excess glucose in the blood, so the kidneys respond by eliminated large amounts of water and salt. This causes intense dehydration and fluid and electrolyte imbalance

15. Diabetes Review 1. What does the body normally use for energy? 2. What allows glucose to be used for energy? 3. What can’t the diabetic “use” glucose for energy even if it’s in his/her bloodstream? 4. What must the diabetic metabolize for energy when carbohydrates (glucose) are “unavailable?” 5. What causes ketones to build up in the blood? 6. What causes the F&E imbalance?

16. Normal Blood Sugar Level 80-120 We cannot survive WITHOUT a blood sugar (glucose) level.

17. Pre-diabetes Before developing Type 2 diabetes, most people develop prediabetes which is when the blood glucose is higher than normal, but not high enough to be called diabetes

19. Types of Diabetes Type 1 or Insulin Dependent (IDDM) Juvenile Diabetes “Brittle” diabetic Usually appears in youth or under age 40 Severe and unpredictable Requires insulin Type 2 or Non-Insulin Dependent (NIDDM) Adult onset Diabetes Makes up 90-95% of all diabetics 10X more common Begins in later years, although seeing more in children d/t obesity

20. Symptoms of Type 1 & 2 Type 1: • Polyuria • Polydipsia • Polyphagia • Glycosuria • Weight loss Type 2: 1. Fatigue • Slow healing wounds • Multiple skin infections, UTI • Vision changes • Obesity

23. 3 “Landmarks” ofTreatment • Drugs: Insulin- injection only! RN only! Insulin pump

25. Treatment Oral Medications Only for Type 2

26. Treatment 2. Diet • Weight reduction • Diabetic diet/Exchange system: Utilizes exact calorie count, measuring foods to individual needs.

27. Diabetic Exchange Diet If you have diabetes, your doctor may put you on a diabetic exchange diet to help control both your weight and the amount of sugar and cholesterol in your blood. You will need to measure your food while on this diet, and you will probably need to eat 3 meals and 1 to 3 snacks daily. This diet divides the foods you can eat into 6 groups and measures each food by exact serving size. That way you can be sure to eat the right amount from each food group daily.

28. Treatment 3. Exercise: Helps keep body fit Burns off calories Helps control glucose stores

29. Complications of Diabetes Acute Complications 1. Insulin Shock/Too much insulin/Hypoglycemia 2. Diabetic Coma/Too much glucose/Hyperglycemia Chronic Complications 3. Circulatory System Complications 4. Nervous System Complications

30. Acute: Hypoglycemia/Insulin Shock/What is it??? 1. Hypoglycemia/Insulin Shock • Sudden onset • BS drops below 70, so insulin level increases Causes: Received too much insulin Too much physical activity Stress Vomiting

31. Acute: Hypoglycemia/Insulin Shock Symptoms: Excessive sweating Rapid breathing Fainting Moist, clammy skin Numbness Agitated, nervousness Pale Slurred speech Rapid, thready pulse

32. Acute: Hypoglycemia/Insulin Shock Treatment: Sugar/OJ if awake IV glucose Oral glucagon

33. Acute: Hyperglycemia/Diabetic Ketoacidosis (DKA)What is it???? 2. Hyperglycemia/Diabetic Coma • Also called KETOACIDOSIS- body becomes too acidic d/t increased levels of ketones in blood • Too much glucose in blood; over 250 • Develops more slowly (can be 24 hours to days) • Usually with Type 1

34. Acute: Hyperglycemia/Diabetic Coma/DKA Causes: Insufficient insulin Stress Illness/infection Dehydration Forgotten medicine Intake of too much food

35. Acute: Hyperglycemia/Diabetic Coma/DKA Why is the blood so acidic? Where are all the ketones coming from? • Medical emergency!!!!

36. Acute: Hyperglycemia/Diabetic Coma/DKA Symptoms: • Headache, drowsiness, confusion • Labored/irregular breathing (Kausmaull’s) • N&V • Weakness Unconsciousness • Flushed and dry skin • Lethargic/confused • Vitals are normal (**at first), then low BP • Sweet, fruity odor to breath

37. Acute: Hyperglycemia/Diabetic Coma/DKA Treatment: IV insulin Fluids Electrolytes

38. Chronic Complications • Circulatory System Complications: Increased levels of glucose in blood, overtime, causes RBC to become stiff damaging the vessels especially the smaller capillaries. This causes poor circulation. The poor circulation has systemic affects: • Decreased ability to fight infection • Poor healing • Diabetic Retinopathy (eye disease leading to blindness) • Kidney disease

39. Chronic Complications • Nervous System Complications: The higher than normal levels of glucose in the bloodstream overtime, also damage the small nerves that extend to the periphery. This causes: • Peripheral Neuropathy- pain in nerves • Loss of sensation

41. Diagnostic Tests 1. Glycated hemoglobin test (A1C)- blood test done approximately every 3 months that measures the glucose level in the blood over a prolonged period of time. It provides a “snapshot” of the patient’s diabetic control. It is not a screening test; it helps predict and control the risk for development of the chronic complications.

42. Diagnostic Tests 2. Fingerstick blood sugar- testing a sample of capillary blood to obtain quick and accurate blood sugar level.

43. Fingerstick

44. Diagnostic Tests Urine test- Checking urine for “spilling” of glucose and/or ketones. If the blood has higher than normal levels of glucose and ketones, it will actually “spill over” into the urine. Test will not give an actual number, but rather a 1+, 2+, 3+. Use the multistix to “dip in” urine.

45. Diagnostic Tests

46. Nursing Care Nursing care of the diabetic patient centers around: • Skin care • Foot care • Poor circulation • Peripheral neuropathy • Blood sugar monitoring

47. Nursing Care 1. Prevent skin irritation 2. Inspect skin with all care 3. Special foot care: do NOT cut toe nails, avoid tight fitting shoes, pt. cannot walk barefoot, wash and DRY feet/toes throuroughly. 4. Inspect feet; have patient inspect feet. The peripheral neuropathy AND poor circulation increases risk of infection, gangrene and possible amputation. Pg.739

48. Nursing Care 5. Keep room clutter free 6. Follow appropriate diet/diabetic restrictions. 7. Accurate finger stick/urine testing. 8. Support lifestyle changes with reassurance and psychological encouragement.