Download DiabetesRevisedFall2009

Individuals Experiencing Diabetes
Mellitus
NURS2016
Diabetes Mellitus
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A multisystem disease related to
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Abnormal insulin production
Impaired insulin utilization
Both
Diabetes Mellitus
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Leading cause of heart disease, stroke, adult
blindness, and non-traumatic limb amputation
In Canada, 7th leading cause of death
Hospitalization rates are 2.4 and 5.3 X greater for
adult and child than general population
Diabetes higher in Algoma and Cochrane
The number of Ontarians with diabetes has
increased by 69 per cent over the last 10 years –
and is projected to grow from 900,000 to 1.2 million
by 2010
Local Reality (2007)
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NELHIN 7.5%
Nipissing & Parry Sound 6.7 %
Timiskaming 10%
Ontario as a whole 6.1 %
Type 1
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Formerly known as ‘juvenile diabetes’
Most often occurs under 30 years of age
Peak onset 11-13 years
Type 1
Onset of Disease
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Manifestations develop when the pancreas
can no longer produce insulin
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Rapid onset of symptoms
Present in ER with ketoacidosis
Type 1
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Weight loss
Polydipsia
Polyuria
Polyphagia
Type 1
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Diabetic Ketoacidosis
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Occurs in the absence of exogenous insulin
Life threatening
Results in metabolic acidosis
Type 2
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Formerly called ‘adult onset diabetes’
Accounts of 90% of patients with diabetes
Usually >40 years of age
Recently seen in children as young as 10
80-90% are overweight
Type 2
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Onset of disease is gradual
May be undetected for years
Recommended blood glucose
targets for people with diabetes*
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HB AIC**
Fasting blood glucose/ blood glucose before meals (mmol/L)
Blood glucose two hours after eating (mmol/L)
Target for most patients with diabetes ≤7.0% 4.0 to 7.0 5.0 to
10 Normal range ≤6.0% 4.0 to 6.0 5.0 to 8.0
* This information is based on the Canadian Diabetes Association 2008
Clinical Practice Guidelines for the Prevention and Management of
Diabetes in Canada and is a guide. Talk to your doctor about YOUR
blood glucose target ranges. ** A1C is a blood test that indicates an
average of your overall blood glucose levels over the past 120 days.
A1C targets for pregnant women and children 12 years of age and
under are different.
Diabetes Mellitus
Collaborative Care
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Goals of diabetes management
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Reduce symptoms
Promote well-being and quality of life
Prevent acute complications
Delay onset and progression of long-term
complications
Clinical Manifestations
Polyuria
Polydipsia
Polyphagia
Weight Loss
Blurred Vision
Asymptomatic
Type I
Most times
Most times
Most times
Most times
Sometimes
Never
Type II
Sometimes
Sometimes
Sometimes
Never
Most times
Most times
Diabetic Ketoacidosis
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A medical emergency
Sometimes brought on by stress, surgery,
pregnancy, puberty, infection
#1 cause: person with diabetes not taking
his/her insulin (fed up or non-compliance)
S & S:
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ketosis
dehydration
electrolyte and acid-base imbalance
DKA
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Abd pain
Nausea
Vomiting
Hyperventilation
Fruity odor to breath
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If untreated,
Altered LOC
Coma
death
Diabetic Coma
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Bicarbonate buffering system fails to compensate for
ketosis
Respirations increase in rate and depth (Kussmaul’s
respirations) & breath has fruity or acetone odour
Renal system attempts to excrete ketones which leads
to hemoconcentration
Hemoconcentration impedes blood circulation & leads
to tissue anoxia & lactic acid production
The rise in lactic acid production further acidifies blood
pH
Rising ketones eventually overwhelms the body’s
defenses against the acid & the body succumbs to
coma
Hypoglycemia
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To treat low blood sugar the 15/15 rule is usually applied.
Eat 15 grams of carbohydrate and wait 15 minutes. The
following foods will provide about 15 grams of carbohydrate:
3 glucose tablets
Half cup (4 ounces) of fruit juice or regular soda
6 or 7 hard candies
1 tablespoon of sugar
After the carbohydrate is eaten, the person should wait
about 15 minutes for the sugar to get into their blood. If the
person does not feel better within 15 minutes more
carbohydrate can be consumed. Their blood sugar should
be checked to make sure it has come within a safe range.
Diabetes Mellitus
Collaborative Care
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Patient teaching
Nutritional therapy
Drug therapy
Exercise
Self-monitoring of blood glucose
Complications: Acute
Acute
 Hypoglycemia: sweating, tremor, tachycardia,
palpitations, nervousness, hunger, -- confusion,
numbness lips/tongue, slurred speech, -irrational/combative behaviour – disoriented,
seizures, loss of consciousness
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Immediate Treatment: 15gm of fast-acting carb
Complications: Acute
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Diabetic Ketoacidosis
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Hyperglycemia – dehydration and electrolyte loss, acidosis
Polyuria, polydipsia, blurred vision, dehydration, weakness,
headache
Tx: rehydration, electrolyte balance, reversing acidosis
Monitoring fld/electrolyte status, glucose levels,
administering insulin drip – blood glucose is usually
corrected before acidosis
Complications: Long-Term
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Angiopathy
Retinopathy
Nephropathy
Neuropathy
Skin problems
Infection
Nutritional Therapy
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Overall goal: assist people in making
changes in nutrition and exercise habits that
will lead to improved metabolic control
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Canada’s Food Guide Exchange System
Nutritional therapy
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Type 1
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Meal plan based on the individual’s usual food
intake and is balanced with insulin and exercise
patterns
Type 2
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Emphasis placed on achieving glucose, lipid, and
blood pressure goals
Caloric reduction
Nutritional therapy
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Food composition
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Individual meal plan developed with a dietician
Nutritionally balanced
Does not prohibit the consumption of any one
type of food
Dietician provides initial support
Exercise
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Essential part of diabetes management
Increases insulin sensitivity
Lowers blood glucose levels
Decreases insulin resistance
Several small complex carbohydrate snacks
can be taken q30m during exercise
Exercise
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Best done after meals
Monitor blood glucose levels before, during
and after exercise
Blood Glucose Monitoring
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Enables patient to make self-management
decisions
Important for detecting episodic hypo or
hyperglycemic events
Nursing Management
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Assessment
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Weight loss/gain
Thirst
Hunger
Healing pattern
Nursing Management
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Nursing diagnosis
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Ineffective therapeutic regime management
Fatigue
Risk for infection
Powerlessness
Nursing Management
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Goals
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Active patient participation
No episodes of acute hypo or hyperglycemia
Maintaining normal blood glucose levels
Prevent complications
Lifestyle adjustment with minimal stress
Ontario Launches Diabetes
Strategy
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$741 Million Plan Will Make Patients
Partners In Care July 22, 2008
Ontario is investing $741 million in new
funding on a comprehensive diabetes
strategy over four years to prevent, manage
and treat diabetes.
Diabetes Strategy
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The strategy includes an online registry that
will enable better self-care by giving patients
access to information and educational tools
that empower them to manage their disease.
The registry will also give health care
providers the ability to easily check patient
records, access diagnostic information and
send patient alerts.
Key elements of the strategy
Increasing access to teaminclude :
based care closer to home by
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Improving access to insulin
pumps and supplies for more
than 1300 adults with type 1
diabetes by funding these
services for people over the
age of 18.
Expanding chronic kidney
disease services, including
greater access to dialysis
services.
Implementing a strategy to
expand access to bariatric
surgery.
Educational campaigns to
prevent diabetes by raising
awareness of diabetes risk
factors in high risk populations,
such as the Aboriginal and
South Asian communities.
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mapping the prevalence of
diabetes across the province
and the location of current
diabetes programs in order to
align services and address
service gaps.
Ontario’s diabetes strategy will
help tackle a growing – and
expensive – health care
challenge.. Treatment for
diabetes and related conditions
such as heart disease, stroke,
and kidney disease currently
cost Ontario over $5 billion
each year.