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Diabetes

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Title: Diabetes


1
Diabetes Insulin
2
Diabetes Mellitus I
  • Diabetes is a metabolic disorder that affects the
    way your body handles energy you get from the
    food you eat
  • Normally, the food that you eat gets broken down
    into a smaller form of sugar (glucose) that is
    absorbed into the bloodstream. With the help of
    insulin, it enters your cells or opens the cells
    like a key, where the nutrients are used as
    energy

3
  • It is estimated that
  • 18.2 million people in the U.S. have diabetes

4
To produce or not to produce
  • People with diabetes either do not produce
    insulin
  • Or
  • They do not use the insulin their body already has

5
Types of diabetes
  • Type I
  • Type II
  • Gestational Diabetes

6
Type I Diabetes (IDDM)
  • Usually diagnosed in children and young adults
  • Type I occurs when the pancreas abruptly stops
    making insulin

7
Type II (NIDDM)
  • Occurs in people over the age of 40, but is
    occurring more frequently in children due to the
    rise of obesity
  • About 90 of pts with diabetes, have Type II

8
Type II
  • One of two things can happen in Type II
  • 1 some insulin is still produced but not
    enough to maintain normal glucose levels
  • Or
  • 2 the body just doesnt respond to the insulin
    being produced (resistant)

9
Gestational Diabetes
  • Occurs in pregnant women who previously didnt
    have diabetes
  • In gestational diabetes, the body is unable to
    produce an adequate amount of insulin

10
The Treatment of Diabetes
  • Keeping control of blood glucose levels can
    reduce the risk of complications and can slow the
    progression of the disease
  • Type I usually receives insulin injections
  • Type II - usually can stay controlled with diet
    exercise, p.o. medications, or insulin if not
    controlled

11
Insulin
  • Produced in the Beta cells of the Islets of
    Langerhans in the pancreas

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Why do we need insulin?
  • Insulin is needed to lower blood sugar in the
    blood, it does this because
  • Insulin is the key and opens the cells of the
    body
  • Once the cells are open, the nutrients and
    sugar go into the cell and dont stay in the
    blood

14
Problem with inadequate or no insulin
  • Inadequate secretion of insulin results in
    improper metabolism of carbs and fats and brings
    on diabetes characterized by hyperglycemia and
    glycosuria high sugar in blood and high sugar in
    urine
  • The condition that results from the above
    information is called DIABETES

15
2 types of diabetes
  • Type I can start out in children or usually by
    the age of 30 y.o. This patient needs insulin to
    lower blood sugar
  • Type II requires the use of pills to lower
    blood sugar. These are called Antidiabetics such
    as Actos and glucotrol/glipizide,
    Glucotrol/Metformin

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Causes of Diabetes Type I
  • There is no cause or cure for diabetes
  • Parents and patients will always ask if something
    they did, caused diabetesanswer is NO
  • Type II can be cured today, with diet, exercise
    and carb control (usually)

20
So what happens when you dont make insulin?
Its not a big deal
  • Hyperglycemia
  • Hypoglycemia
  • See handout on this

21
Hyperglycemia
  • Person ends up with an excessive amount of sugar
    in the blood stream
  • Pts with hyperglycemia can go into DKA will have
    fruity smelling breath along with Kussamaul
    respirations
  • Do you remember ketones are being burned for
    energy? pink colored urine strip, wt loss,
    acidic blood

22
Signs Symptoms of Ketoacidosis
  • Extremely elevated blood sugars, have been known
    to be as high as 1200s
  • Fruity smelling breath
  • Tachycardic
  • Hypotension d/t dehydration from 3Ps
  • Coma-like statedrowsy
  • Kussamauls respirations think of ketoacidosis

23
Treatment for DKA?
  • Hydration
  • IV insulin what kind of insulin?
  • Electrolyte replacement

24
What kind of care does the nurse provide to a pt
with hyper or hypoglycemia?
  • You MUST monitor the BG every 30 minutes,
    especially once treatment to fix the problem has
    taken place
  • Never leave your pt alone for an extended period
    of time..stay on top of this type of problem
  • Use this time as a time to teach the pt more
    about their diabetic condition

25
INSULIN
26
Sliding Scale
  • Sliding scales are used to cut the blood sugar
    fairly quickly
  • Sliding scales are written to be given in
    conjunction WITH normal daily insulin
  • Sliding scale insulin is always fast acting,
    therefore, the only insulin you should see on a
    S.S. is REGULAR insulin or rapid acting log

27
1 Example of a Sliding scale
  • 130-150 2u Reg S.Q.
  • 151-170 4u Reg S.Q.
  • 171-190 6u Reg S.Q
  • 191- 210 notify H.O.
  • If pt usually gets 4u Reg with breakfast and his
    current accu-check is 174, how much insulin will
    you administer?

28
Another Example of a Sliding Scale
  • 125 145 2u
  • 146 160 4u
  • 161 180 6u
  • 181 200 Call H.O
  • AM insulin order 4u Humulog QD
  • Pts accu-check in a.m. is 171, how much insulin
    will you give?

29
Dr. will decide on a sliding scale or not
  • NOT ALL PTS HAVE SLIDING SCALES
  • Check Dr.s order to see if there is a sliding
    scale along with ordered insulin dose

30
What actually is a bottle of insulin
  • Insulin from a vial is a protein, obtained from
    that pancreas of a bovine (pertains to cattle)
    and porcine (pertains to pig) that affects
    metabolism of glucose
  • When prepared medically, insulin is prepared from
    pork of beef

31
What Happens When We Eat?
  • We eat, swallow, and the food gets churned and
    broken down in the stomach.
  • It passes through the sm. intestine where more
    breaking down occurs.
  • This triggers the pancreas to send out insulin to
    the blood.
  • Upon the nutrients getting ready to be sent to
    the bloodstream and then into cells, insulin
    comes along and opens all of the cells.
  • The nutrients enter the blood and then the cells
    and then we are happy! ?

32
How does insulin work you ask?
  • When injected into a person with Diabetes, it
    produces the following effects
  • Normal storage of glycogen in the liver and
    muscle tissue
  • Causes a reduction in blood sugar level by
    facilitating the metabolism of glucose
  • Causes a disappearance of Ketones

33
Insulin
  • Is ALWAYS expressed in units NOT mls

34
How can insulin be administered, via what route?
  • REGULAR insulin is the only insulin that can be
    given SQ or IV drip

35
Insulin comes in various types according to how
fast it works
  • 1. Rapid
  • 2. Short acting
  • 3. Intermediate
  • 4. Long acting

36
We will discuss the following
  • Rapid acting Novolog and Humalog
  • Short acting Regular
  • Intermediate - NPH
  • Long acting known as Lantus
  • There are many other insulins to know but not for
    this class, youll get more in next semester.
    See full chart in hand-out

37
Obtaining a blood glucose reading
  • You can do this with the use of a blood
    glucometer
  • Or in obtaining a venipuncture

38
Where to poke the finger?
  • NEVER POKE DIRECTLY IN THE MIDDLE OF THE PAD,
    this hurts and bleeds too much
  • Use a place along side the nail bed region, in
    the upper most portion of the finger

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Route of insulin?
  • All must be given Subcutanously
  • Only one can be given IV _____________
  • NEVER GIVE INSULIN IMtakes too long to act

48
Preparing insulin
  • Roll the vials of all insulin except NPH
  • NPH may be gently shaken
  • In the hospital, use alcohol and let it dry
  • Inject SQ at a 45 degree angle
  • No aspiration needed
  • May keep vial unrefrigerated
  • Must mark date, time, initials on newly opened
    insulin

49
Insulin Syringe insulin syringes have orange caps
50
Drawing up insulin
  • Always requires 2 nurses to check the dosage
  • Checking the insulin dosage with another nurse
    will help protect against overdose, adverse
    reactions and error from occurring

51
Acceptable site to administer insulin into
52
How to administer insulin?
  • ALWAYS SQ
  • This is given at a 45 degree angle
  • No rubbing of the injection site
  • NO aspiration of insulin upon administration
  • Absorption occurs most quickly in the ABDOMEN
    followed by the arms, thigh, hips

53
Choosing which site to inject
  • SITE ROTATION is a MUST
  • If you continue to inject into the same site,
    lipodystrophy will occur.
  • Lipodystrophy is the build up of fat or scarring
    in the SQ tissue. Insulin injected here will not
    absorb correctly uncontrolled, erratic blood
    glucose readings

54
Injecting insulin into exercised limbs
  • If a pt is planning to exercise, do not inject
    into areas of the body that will be moving. This
    will cause an increase in the absorption of that
    insulin too quickly

55
Using new syringes vs. used ones?
  • Each time a pt uses an insulin syringe for their
    dose of insulin, the syringe should be discarded
    into the proper waste container
  • Coffee can or approved needle box should be used
    to avoid needle sticks to others
  • Pts will frequently cleanse the end of a used
    insulin syringe only to reuse it to save .
    Cellulitis or other contaminants may cause
    problems for the pt. Always encourage to use of
    a new syringe with each injection/dose

56
Pre-filled insulin syringe
  • These are prepared by drug companies and look
    similar to a chunky ink pen. Pt dials up the
    amount of insulin needed and that amount is
    delivered. This alleviates the need to measure
    the amount using ones own vision
  • Kids can use this pen

57
Oral hypoglycemics
  • Are not oral insulin (FYI did you know that if
    you attempted to take SQ insulin by mouth your
    stomach acid and enzymes would dismantle insulin?
    Insulin can ONLY be taken SQ)
  • You must make some insulin to get these pills
  • Therefore.
  • Only Type II can take these

58
Oral hypoglycemics or anti-diabetic pills
  • Glucatrol (glipizide)
  • Diabeta, Micronase (glyburide)
  • Metformin (glucophage)
  • Precose (acrabose)
  • Avandia (rosiglitazone)

59
Oral hypoglycemics work in 1 of 3 ways
  • 1.) Increase the amt of insulin the beta cells
    make by stimulating the beta cells to release
    more insulin
  • 2.) Improves insulin sensitivity by making the
    receptor cells more receptive
  • 3.) Stops the liver from making glucose
  • All of these will change the amt of glucose left
    in the blood
  • KNOW THIS FOR 2ND SEMESTER CLINICALS FOR STOCKWELL

60
Problems with high blood sugar
  • Remember this is called hyperglycemia
  • Over time, high blood sugars damage organs such
    as eyes, blood vessels, skin, glomerulus

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Normal Blood glucose levels
  • 70-110mg/dl

63
Lab tests
  • Hemoglobin A1c is ordered to detect ones blood
    glucose levels over a 3month period
  • Pts get caught cheating with this test
  • Normal level today should be 6 or less
  • If you are over 7, Dr. scolds you

64
Other serious problems that occur with high blood
sugars
  • Stroke
  • M.I.
  • Renal failure
  • blindness

65
Diet
  • Pts are now taught to control blood glucose
    levels by controlling the intake of carbohydrates
  • Carbohydrates break down into a smaller form of
    glucose that fits through the digestive track and
    out into the blood
  • Pts are now counting carbohydrate servings. 1
    serving of carb 15 grams of carbohydrates
  • Pts are then told to eat 3-5 servings /meal
    depending on your age, size and gender

66
Diet for the diabetic client
  • Diet must be tailored to meet the pts needs
  • Not all pts eat the same things
  • Not all pts have the same schedule
  • If a Dietician isnt consulted, chances are that
    the pt will not be compliant

67
The Diabetic Diet is Aimed at 5 Criteria That
Should Be Followed
  • 1) Maintain as near normal blood glucose levels
    as possible
  • 2) Achieve optimal serum lipid levels
  • 3) Provide adequate calories to maintain a
    reasonable weight
  • 4) Prevent complications of diabetes
  • 5) Improve overall health

68
American Diabetic Association (ADA)
  • Recommends eating from the My Food Pyramid
  • Eating less saturated fats and cholesterol
  • Eating less sodium
  • Individuals taking insulin or oral hypoglycemics
    should eat at consistent times synchronized with
    the actions of the medications used
  • Distribute calories eaten over 24 hours with
    eating regular meals and snacks. This will
    prevent extreme highs or lows in blood glucose
    readings

69
Once the diagnosis is made
  • MUCH teaching needs to be done
  • This teaching needs to be done by YOU

70
Education
  • Lots of education is needed with diabetes
  • Nurses play a huge role in educating

71
TEST
  • Where do we poke the finger when obtaining BG
    readings?
  • A. pad
  • B. side near nail
  • C. palm
  • D. near the palm

72
Can a diabetic client eat whatever he wants?
  • A. Yes
  • B. No

73
A BG reading of 89 is?
  • A. low
  • B. high
  • C. normal

74
A BG reading of 210 is?
  • A. low
  • B. high
  • C. Normal

75
What color is NPH insulin?
  • A. clear
  • B. cloudy

76
Which type of insulin can only be given IV
  • A. regular
  • B. NPH
  • C. Lantus
  • D. 70/30

77
What type of insulin can only be used in a
sliding scale?
  • A. NPH
  • B. Lantus
  • C. Regular/Humalog
  • D. no insulin can be used in a sliding scale

78
Can you use a TB syringe to administer insulin?
  • A. Yes
  • B. No

79
What kind of unique breath will we see in the pt
with DKA?
  • A. Foul
  • B. alcohol-like
  • C. Fruity
  • D. sulfer-like

80
The End
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