Exam #3
Care of Patients with Diabetes
Diabetes Mellitus
o A metabolic disorder resulting from either an inadequate production of
insulin (type 1) or an inability of the body’s cells to respond to insulin that
is present (type 2).
Type 1 Diabetes
o An autoimmune dysfunction involving the destruction of beta cells, which
produce insulin in the islets of Langerhans of the pancreas
o Develops as a child or can hit in early adult age groups
o Beta cells stop creating insulin
o Only treat with insulin
o Viral infections such as mumps may trigger autoimmune destructive
actions.
o The immune system fails to recognize normal body cells as “self” and
immune system cells and antibodies take destructive actions against thr
insulin secreting cells in the islets.
Type 2 Diabetes
o Progressive condition due to increasing inability of cells to respond to
insulin (insulin resistance) and decreased production of insulin by the beta
cells.
o Progressive, society is doing it to themselves
o High glucose levels damage tissues, cells respond to insulin
o Develops from obesity, and physical inactivity in a genetically susceptible
adult, accompanied by cardiovascular risk factors of hyperlipidemia,
hypertension, and increased clot formation.
o Metabolic Syndrome
Increase risk of type 2 DM
Abdominal obesity
Hyperglycemia
Hypertension
Hyperlipidemia
o African Americans & Hispanic populations more at risk
Both Types are linked to…
o Obesity
o Sedentary lifestyle
o Heredity
DM Effects & Prevalence
o Cardiovascular disease
o Hypertension
o Kidney disease
o Neuropathy
o Retinopathy
, o Peripheral vascular disease
o Stroke
o Immunity is compromised & wound healing
o When you are a diabetic you are always a diabetic & it usually leads to
more problems
Health Promotion & Disease Prevention
o Diabetic Screening
Determine Risk Factors of
» Obesity
» HTN
» Sedentary Lifestyle
» Hyperlipidemia
» Cigarette Smoking
» Genetic Hx
» Ethnic Group
» Women who have polycystic ovary syndrome of delivered
infants weighing more than 9 lbs
The American Diabetes Association recommends screening a client
who has a BMI greater than 25 and age greater than 45 years, or if
a child is overweight and has additional risk factors.
Screening is done with fasting serum glucose levels or
glycosylated hemoglobin (A1C).
Genetic = parent who has diabetes child has a higher risk
Insulin resistance = PCOS & baby weighing more than 9 lbs
Type 2 = lifestyle and diet/not reversible but controllable
Client Education
o Exercise & good nutrition are necessary for preventing and controlling
DM
Carbs: 45% of daily intake
Protein: 15% to 20% of total daily intake, depending renal function
Unsaturated fats and polyunsaturated fats: 20% to 35% of total
daily intake.
Increase “good cholesterol” and decrease “bad cholesterol”
o Consistency in the amount of food consumed and regularity in meal times
o Encourage a diet low in saturated fats to decrease low-density lipoprotein
(LDL).
o Modify the client’s diet to include omega-3 fatty acids and fiber to lower
cholesterol
o Encourage physical activity at least three times per week.
o Protein = wound healing, maintains glucose levels
o 7% of bad fats
Glucose Testing
o Fasting Plasma Glucose
Determines blood glucose when the client has consumed no foods
or fluids (other than water) for the past 8 hr.
, Fasting blood glucose greater than 126 mg/dL on two different
occasions can indicate diabetes mellitus.
o Expected Reference Range
70 to 110 mg/dL for adults and children older than 2 years
Slightly increased for adults older than 50 years
o Most simple, fast for full 8 hours only drink water or black coffee, get
blood drawn
o If less than 126 = happy
o Greater than 126 = sad
Oral Glucose Tolerance Test
o Doesn’t require pregnancy
o Greater than 140 = problem / gestational diabetes
o Classic time is 2 hours to get blood drawn
o Blood glucose greater than 140 mg/dL at 2 hr following glucose ingestion
can indicate diabetes. The test may be repeated on another day to verify
results.
Determines the ability to metabolize a standard amount of glucose.
o Expected Reference Range
Less than 200 mg/dL 1 hr following glucose ingestion
Less than 140 mg/dL 2 hr following glucose ingestion
70 to 115 mg/dL 3 or 4 hr following glucose ingestion
Glycosylated Hemoglobin
o Glycosylated hemoglobin (HbA1c)
HbA1c is the best indicator of an average blood glucose level for
the past 120 days.
Assists in evaluating treatment effectiveness and adherence to the
diet plan, medication regimen, and exercise schedule.
Less than 7 = happy for a diabetic
6.5 or more for a normal person = start looking at them as a
diabetic
If patient is controlling glucose through diet and is still high, can
readjust meds
Recommended twice a year if making expecting treatment
outcomes
o Expected Reference Range
HbA1c 5.7% or less indicates no diabetes mellitus.
HbA1c less than 7% indicates good diabetes control.
HbA1c 8% to 9% indicates fair diabetes control.
HbA1c 9% or greater indicates poor diabetes control.
Screening
o Should be done in adults 45 or older and those defined as overweight
o Younger than 45 if overweight
Expected Findings
o Hyperglycemia
Blood glucose level usually greater than 250 mg/dL
, o Polyuria
Excess urine production and frequency from osmotic diuresis
o Polydipsia
Excessive thirst due to dehydration
Loss of skin turgor, skin warm and dry
Dry mucous membranes
Weakness and malaise
Rapid weak pulse and hypotension
o Polyphagia
Excessive hunger and eating caused from inability of cells to
receive glucose (because of a lack of insulin or cellular resistance
to available insulin) and the body’s use of protein and fat for
energy (which causes ketosis)
The client can display weight loss.
Ketones accumulate in the blood due to breakdown of fatty acids
when insulin is not available, resulting in metabolic
acidosis.
Kussmaul respirations: increased respiratory rate and depth in
attempt to excrete carbon dioxide and acid due to metabolic
acidosis.
o Other Manifestations
Acetone/fruity breath odor (due to accumulation of ketones),
headache, nausea, vomiting, abdominal pain, inability to
concentrate, fatigue, weakness, vision changes, slow healing of
wounds, decreased level of consciousness, seizures leading to
coma
Triangle of Diabetes Management
o MED – Medication, exercise, diet
o Exercise 3 to 4 times a week or more.
o Consistent frequency through out the week
o 60 to 80% of HR = Elevate HR and breathing heavier
o Time = 20 to 30 min with a 5 to 10 minutes warm up & a cool down.
o Type 1 Diabetics
Perform vigorous exercise with BS is 100-250 mg/dL
NO KETONES FOUND IN THE URINE
Have a snack available if s/s hypoglycemia occur
Eat a snack before if BS is low 100s
Chart 64-4 Exercise
o Teach pt about the relationship between regularly scheduled exercise &
blood glucose levels, blood lipid levels, and complications
o Reinforce the level of exercise recommended for the patient based on his
or her physical health
o Instruct pt to wear appropriate footwear
o Remind the pt to examine his or her feet daily and after exercising
Care of Patients with Diabetes
Diabetes Mellitus
o A metabolic disorder resulting from either an inadequate production of
insulin (type 1) or an inability of the body’s cells to respond to insulin that
is present (type 2).
Type 1 Diabetes
o An autoimmune dysfunction involving the destruction of beta cells, which
produce insulin in the islets of Langerhans of the pancreas
o Develops as a child or can hit in early adult age groups
o Beta cells stop creating insulin
o Only treat with insulin
o Viral infections such as mumps may trigger autoimmune destructive
actions.
o The immune system fails to recognize normal body cells as “self” and
immune system cells and antibodies take destructive actions against thr
insulin secreting cells in the islets.
Type 2 Diabetes
o Progressive condition due to increasing inability of cells to respond to
insulin (insulin resistance) and decreased production of insulin by the beta
cells.
o Progressive, society is doing it to themselves
o High glucose levels damage tissues, cells respond to insulin
o Develops from obesity, and physical inactivity in a genetically susceptible
adult, accompanied by cardiovascular risk factors of hyperlipidemia,
hypertension, and increased clot formation.
o Metabolic Syndrome
Increase risk of type 2 DM
Abdominal obesity
Hyperglycemia
Hypertension
Hyperlipidemia
o African Americans & Hispanic populations more at risk
Both Types are linked to…
o Obesity
o Sedentary lifestyle
o Heredity
DM Effects & Prevalence
o Cardiovascular disease
o Hypertension
o Kidney disease
o Neuropathy
o Retinopathy
, o Peripheral vascular disease
o Stroke
o Immunity is compromised & wound healing
o When you are a diabetic you are always a diabetic & it usually leads to
more problems
Health Promotion & Disease Prevention
o Diabetic Screening
Determine Risk Factors of
» Obesity
» HTN
» Sedentary Lifestyle
» Hyperlipidemia
» Cigarette Smoking
» Genetic Hx
» Ethnic Group
» Women who have polycystic ovary syndrome of delivered
infants weighing more than 9 lbs
The American Diabetes Association recommends screening a client
who has a BMI greater than 25 and age greater than 45 years, or if
a child is overweight and has additional risk factors.
Screening is done with fasting serum glucose levels or
glycosylated hemoglobin (A1C).
Genetic = parent who has diabetes child has a higher risk
Insulin resistance = PCOS & baby weighing more than 9 lbs
Type 2 = lifestyle and diet/not reversible but controllable
Client Education
o Exercise & good nutrition are necessary for preventing and controlling
DM
Carbs: 45% of daily intake
Protein: 15% to 20% of total daily intake, depending renal function
Unsaturated fats and polyunsaturated fats: 20% to 35% of total
daily intake.
Increase “good cholesterol” and decrease “bad cholesterol”
o Consistency in the amount of food consumed and regularity in meal times
o Encourage a diet low in saturated fats to decrease low-density lipoprotein
(LDL).
o Modify the client’s diet to include omega-3 fatty acids and fiber to lower
cholesterol
o Encourage physical activity at least three times per week.
o Protein = wound healing, maintains glucose levels
o 7% of bad fats
Glucose Testing
o Fasting Plasma Glucose
Determines blood glucose when the client has consumed no foods
or fluids (other than water) for the past 8 hr.
, Fasting blood glucose greater than 126 mg/dL on two different
occasions can indicate diabetes mellitus.
o Expected Reference Range
70 to 110 mg/dL for adults and children older than 2 years
Slightly increased for adults older than 50 years
o Most simple, fast for full 8 hours only drink water or black coffee, get
blood drawn
o If less than 126 = happy
o Greater than 126 = sad
Oral Glucose Tolerance Test
o Doesn’t require pregnancy
o Greater than 140 = problem / gestational diabetes
o Classic time is 2 hours to get blood drawn
o Blood glucose greater than 140 mg/dL at 2 hr following glucose ingestion
can indicate diabetes. The test may be repeated on another day to verify
results.
Determines the ability to metabolize a standard amount of glucose.
o Expected Reference Range
Less than 200 mg/dL 1 hr following glucose ingestion
Less than 140 mg/dL 2 hr following glucose ingestion
70 to 115 mg/dL 3 or 4 hr following glucose ingestion
Glycosylated Hemoglobin
o Glycosylated hemoglobin (HbA1c)
HbA1c is the best indicator of an average blood glucose level for
the past 120 days.
Assists in evaluating treatment effectiveness and adherence to the
diet plan, medication regimen, and exercise schedule.
Less than 7 = happy for a diabetic
6.5 or more for a normal person = start looking at them as a
diabetic
If patient is controlling glucose through diet and is still high, can
readjust meds
Recommended twice a year if making expecting treatment
outcomes
o Expected Reference Range
HbA1c 5.7% or less indicates no diabetes mellitus.
HbA1c less than 7% indicates good diabetes control.
HbA1c 8% to 9% indicates fair diabetes control.
HbA1c 9% or greater indicates poor diabetes control.
Screening
o Should be done in adults 45 or older and those defined as overweight
o Younger than 45 if overweight
Expected Findings
o Hyperglycemia
Blood glucose level usually greater than 250 mg/dL
, o Polyuria
Excess urine production and frequency from osmotic diuresis
o Polydipsia
Excessive thirst due to dehydration
Loss of skin turgor, skin warm and dry
Dry mucous membranes
Weakness and malaise
Rapid weak pulse and hypotension
o Polyphagia
Excessive hunger and eating caused from inability of cells to
receive glucose (because of a lack of insulin or cellular resistance
to available insulin) and the body’s use of protein and fat for
energy (which causes ketosis)
The client can display weight loss.
Ketones accumulate in the blood due to breakdown of fatty acids
when insulin is not available, resulting in metabolic
acidosis.
Kussmaul respirations: increased respiratory rate and depth in
attempt to excrete carbon dioxide and acid due to metabolic
acidosis.
o Other Manifestations
Acetone/fruity breath odor (due to accumulation of ketones),
headache, nausea, vomiting, abdominal pain, inability to
concentrate, fatigue, weakness, vision changes, slow healing of
wounds, decreased level of consciousness, seizures leading to
coma
Triangle of Diabetes Management
o MED – Medication, exercise, diet
o Exercise 3 to 4 times a week or more.
o Consistent frequency through out the week
o 60 to 80% of HR = Elevate HR and breathing heavier
o Time = 20 to 30 min with a 5 to 10 minutes warm up & a cool down.
o Type 1 Diabetics
Perform vigorous exercise with BS is 100-250 mg/dL
NO KETONES FOUND IN THE URINE
Have a snack available if s/s hypoglycemia occur
Eat a snack before if BS is low 100s
Chart 64-4 Exercise
o Teach pt about the relationship between regularly scheduled exercise &
blood glucose levels, blood lipid levels, and complications
o Reinforce the level of exercise recommended for the patient based on his
or her physical health
o Instruct pt to wear appropriate footwear
o Remind the pt to examine his or her feet daily and after exercising
