Transcript Diabetes PP

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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
Cause is not fully understood;
however, incidence is increase by:
 Heredity
 Obesity
 Age
 Diet
 Lack of exercise
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
starches and 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.
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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
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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.
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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?
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.
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.
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-next nutrient class used for
energy
Ketones-acid by products of fat metabolism
Fluid & Electrolyte (F&E) Imbalance-when
fluids and electrolytes (potassium, sodium) are
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.
Because cells can’t metabolize or use the
glucose, they have to get energy
somewhere else, so they metabolize fats
and proteins.
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
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?
80-120
We cannot survive WITHOUT a
blood sugar (glucose) level.
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
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
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Type 1:
Polyuria
Polydipsia
Polyphagia
Glycosuria
Weight loss
Type 2:
1. Fatigue
2.
Slow healing wounds
3.
Multiple skin
infections, UTI
4.
Vision changes
5.
Obesity
1.
Drugs:
Insulin- injection only!
RN only!
Insulin pump
Oral Medications
Only for Type 2
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Diet
Weight reduction
Diabetic diet/Exchange system:
Utilizes exact calorie count,
measuring foods to
individual needs.
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.
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Exercise:
Helps keep body fit
Burns off calories
Helps control glucose stores
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
1. Hypoglycemia/Insulin Shock
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Sudden onset
BS drops below 70, so insulin level increases
Causes: Received too much insulin
Too much physical activity
Stress
Vomiting
Symptoms:
Excessive sweating
Fainting
Numbness
Pale
Slurred speech
Rapid, thready pulse
Rapid breathing
Moist, clammy skin
Agitated, nervousness
Treatment:
Sugar/OJ if awake
IV glucose
Oral glucagon
2. Hyperglycemia/Diabetic Coma
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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
Causes:
Insufficient insulin
Stress
Illness/infection
Dehydration
Forgotten medicine
Intake of too much food
Why is the blood so acidic?
Where are all the ketones coming
from?
 Medical
emergency!!!!
Symptoms:
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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
Treatment:
IV insulin
Fluids
Electrolytes
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:
1. Decreased ability to fight infection
2. Poor healing
3. Diabetic Retinopathy (eye disease leading to
blindness)
4. Kidney disease
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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:
1. Peripheral Neuropathy- pain in nerves
2. Loss of sensation
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.
2. Fingerstick blood sugar- testing a sample
of capillary blood to obtain quick and
accurate blood sugar level.
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.
Nursing care of the diabetic patient centers
around:
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Skin care
Foot care
Poor circulation
Peripheral neuropathy
Blood sugar monitoring
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
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.