Transcript An introduction to diabetes - Shahid Sadoughi University

An introduction to
diabetes
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 <40yr
Older >40yr
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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Hypoglycaemia
Causes
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
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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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Hypoglycaemia
Treatment 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
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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
Don’t 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 person’s
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