An introduction to diabetes

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An introduction to diabetes
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Aims

• To give an overview of Type 1 and Type 2 diabetes
• To give information on what normal blood glucose
  levels should be
• Discuss hypo and hyper glycaemia
• To identify the complications associated with
  diabetes
• To give information on the different types of
  medication
• To instruct how to monitor blood glucose levels

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Objectives

• The Health Care Assistant will understand the
  differences between Type 1 and Type 2 Diabetes
• The HCA will know what normal blood glucose
  levels should be
• The HCA will know what the complications
  associated with diabetes are
• The HCA will understand what medications are used
  in diabetic control
• The HCA will be able to monitor blood glucose
  level and support the diabetic patient

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What is diabetes?

• Diabetes mellitus is a common condition in which
  the amount of glucose in the blood is too high
  because the body is unable to use it properly
• It can occur at any age but incidence increases
  with age
• The hormone called insulin controls the amount of
  glucose in the blood
• Insulin is made in a gland called the pancreas

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What is diabetes?

• Food is digested and particularly sugary and
  starchy foods are turned into glucose
• Glucose travels round the body in the blood
• Glucose is used for energy
• Insulin moves the glucose from the blood into the
  cells

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Food and Insulin

• Food is taken in and travels through the gut
• The pancreas secretes insulin when we eat
• Food is broken into smaller molecules in the gut
• Some of these are GLUCOSE

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What is diabetes?

• After a meal blood glucose levels rise and
  insulin is normally released into the blood
• Insulin is crucial to stop blood glucose levels
  rising too high
• Diabetes develops when the pancreas is unable to
  produce insulin or when cells cannot use the
  insulin properly

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How the glucose gets into the cells
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What is normal blood glucose?

• The aim is to restore blood glucose levels
  towards normal limits
• General aim 4 7mmols before food
• Hypoglycaemia (low blood sugar) is when blood
  glucose falls below 4mmols
• Blood glucose levels fluctuate throughout the
  day. However persistently high or low readings
  need reviewing

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Two types of diabetes

• Type 1 Develops when there is a severe lack of
  insulin in the body because most or all insulin
  producing beta cells in the pancreas have been
  destroyed. This is treated by insulin injections
  and diet
• Type 2 Develops when pancreas still produces
  insulin but there is cellular resistance and
  insulin cannot be used properly by the body. This
  is treated by diet alone or diet and tablets, or
  diet and insulin injections (Tortora and
  Grabowski 1996)

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Type 1 Type 2
Age of onset Young lt40yr Older gt40yr
Symptoms Yes -very sudden/intense Sometimes -slow gradual onset
Auto immune Yes No
Producing own insulin No Yes
Body Weight Normal Normal/overweight
Treatment Insulin Diet/tablets/Insulin
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Treatment of diabetes

• Diet (healthy eating) and lifestyle interventions
• Oral hypoglycaemic agents
• Injectables (Exenatide Liraglutide)
• Insulin oral hypoglycaemic agents
• Insulin

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Factors affecting glycaemic levels

• Diet (amount,type and frequency of food)
• Alcohol
• Exercise levels
• Stress/emotional upset
• Illness/infection
• Pregnancy

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Things which lower blood glucose

• Insulin injections
• Diabetes tablets
• Exercise
• Forgetting a meal or eating too little

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Things which will raise blood glucose

• Over-eating, particularly starchy or sugary food
• Missing an insulin injection
• Forgetting a tablet
• Illness/infection
• Stress

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HypoglycaemiaCauses

• Too much insulin
• Too many Diabetic tablets
• Not enough food or delayed food intake
• Increased exercise
• Extremes of weather
• Alcohol
• Early Pregnancy

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Hypoglycaemia(below 4 mmol/l) signs and symptoms

• ?

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Hypoglycaemia (below 4 mmol/l) signs and symptoms

• Sweating
• Shaking
• Headaches
• Blurred vision
• Dizziness
• Tingling lips/fingers/tongue
• Palpitations
• Feeling hungry
• Lack of concentration
• Pallor
• Glazed eyes
• Personality changes/behavioural changes

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Hypoglycaemia Treatment

• Group Activity

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Hypoglycaemia Treatment

• Quick acting Sugar
• Glucose Sweets (2-3 sweets)
• Lucozade (small glass)
• Orange Juice (small glass)
• Sugar (2-3 spoonfuls)
• Followed up with longer acting carbohydrate snack

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HypoglycaemiaTreatment continued

• If patient is resisting food can try Glucogel
  (formerly Hypostop) if available
• If unable to swallow/drowsy may use Glycogen if
  available
• If unconscious will need 999 call

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Hyperglycaemia signs and symptoms

• Group Activity

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Hyperglycaemia signs and symptoms

• Thirst
• Tiredness
• Polyuria (frequency passing urine particularly at
  night)
• Weight loss
• Fast breathing
• Vomiting late stages
• Impaired consciousness
• Increased risk of infections (in particular
  thrush)

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Treatment

• Review patient and medication
• Sick day rules
• Seek medical advice if vomiting or getting worse
• Give plenty of fluids
• If not eating, replace food with drinks
• i.e. lucozade / lemonade small glass
• Dont stop insulin / tablets
• Monitor closely

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Dietary Guidelines
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The Main Tablets

• Tablets that help the body to use insulin more
  effectively metformin - usually used in
  overweight people affects the stomach
• Tablets that stimulate the pancreas to produce
  more insulin gliclazide - can cause low blood
  sugar

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Additional Tablets

• Less commonly used
• Post prandial glucose regulators- glinides
• Glitazones
• Sitagliptin / Vitagliptin / Saxagliptin
  (Relatively new)

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New Options

• Dipeptidyl Peptidase 4 Inhibitors
• (DPP-4, Gliptins)
• Sitagliptin
• Vildagliptin
• Saxigliptin

• Glucagon-Like Peptide 1
• (GLP-1)
• Exenatide Byetta
• Liraglutide Victoza

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Injectables

• For people with Type 2 diabetes not to be used
  in Type 1 diabetes
• Exenatide twice a day or a once weekly option
• Liraglutide once a day
• Both to be used in combination with tablets and
  are subcutaneous injections.
• These are not INSULIN

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Insulin

• Once daily long acting can be used in type 2
• Twice daily medium acting can be used in type
  2
• Four times daily one long acting and three
  short acting with meals

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Insulin and Tablets

• Importance of taking these at the correct time
• Why do we say this?
• Insulin and some tablets work with food
• If given at the wrong time can cause
• Low blood sugar
• High blood sugar

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Complications of diabetes

• Eye damage
• Diabetic Retinopathy (bleeding at the back of the
  eye formation of new vessels)
• If untreated can lead to blindness
• People with diabetes need to have annual
  screening for early signs of eye damage

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Retinopathy
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Retinopathy
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Complications of Diabetes

• Kidney damage
• Diabetic Nephropathy (formation of small new
  blood vessels in the kidneys)
• Undetected can lead to renal failure
• People with diabetes need to have good control of
  their blood pressure blood sugar levels to
  reduce the risk of developing these problems

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Kidneys renal disease
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Complications of Diabetes

• Increased risk of Heart Disease Stroke
• Build up of cholesterol (fatty deposits) on the
  linings of the blood vessels restrict the flow of
  blood through the vessels which can lead to heart
  attack strokes
• To reduce the risk
• No smoking
• Good control of blood pressure cholesterol
• Maintain normal weight
• Low fat diet
• Regular exercise

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Heart Disease and Strokes
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Complications of Diabetes

• Foot problems
• Diabetic Neuropathy, damage to the nerve supply
  to the feet
• Affect blood supply to the legs feet
• Leading to reduced/slow healing of any injuries
• Risk can be reduced by maintain good diabetes
  control and good foot care
• Report any cuts, sores, abnormal looking areas
  straight away this may save the persons foot

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Feet-Circulation, sensation and ulcers
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Monitoring Control

• Practical session
• How to take a blood glucose measurement
• Completing blood glucose diary
• Documentation (including prescription charts)
• Safe disposal of sharps

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Procedure

• Identify patient, obtain consent and cooperation
• Wash and dry your hands and apply gloves
• Ensure that patient has washed hands in warm
  soapy water, rinsed and dried completely
• Carefully remove test strip from packaging
• Insert test strip into meter and ensure meter
  coded
• Use Unilet lancing device and puncture finger on
  side of fingertip (outer aspect) avoiding thumb
  and forefinger
• Gently squeeze/massage fingertip to get
• round drop of blood

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• If blood smears do not use this sample. Dry the
  area and gently squeeze another drop of blood. If
  still not effective, puncture a new site with a
  new lancet
• Apply sample as per manufacturers instructions
• Press cotton wool or gauze to puncture site
• Dispose of used lancet and test strip in sharps
  bin
• Remove gloves and wash hands with soap water
• Record BM result in patients notes
• If BM result out of target range,
• act accordingly seek advice
• From Qualified Nurse or GP

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Quiz

• EVALUATION