Diabetes - The Center for Life Enrichment
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Transcript Diabetes - The Center for Life Enrichment
CMT Training
The Center for Life Enrichment
Resource: MTTP Student Manual
Diabetes
is a disorder in which the body
does not properly utilize or release
insulin which results in abnormally high
levels of serum (blood) glucose
In
the normal process of digestion,
consumed sugars and starches
(carbohydrates) and other foods are
changed into a form of sugar called glucose
Glucose is distributed throughout the body
and is used as the energy source for the
body’s cells
The rise in blood sugar associated with
eating triggers the pancreas to secrete the
hormone called insulin
Insulin
is required to allow the blood
glucose to leave the bloodstream and
either enter the body’s cells where it is
used for energy or enter the liver where
it is stored for future use
In diabetes, either the body does not
properly use the insulin that is secreted
by the pancreas or the pancreas secretes
too little or no insulin
If the body does not properly use the insulin that is
secreted by the pancreas or the pancreas secretes
too little or no insulin, the glucose collects in the
blood
These high levels of blood glucose, over time, cause
complications such as:
Damage to the retinas of the eyes (Diabetic Retinopathy)
Nerve damage (Neuropathy)
Kidney failure
Blood vessel damage (increasing the incidence of heart attack
& stroke)
• Reduced circulation (increasing the risk of infection and the
potential for amputation)
• Impotence
• Complications of pregnancy
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TYPE I DIABETES
The pancreas secretes too
little or no insulin
The person must receive
insulin injections to allow
the blood glucose to be
utilized and/or stored
properly
TYPE II DIABETES
The insulin that is produced
by the pancreas cannot be
utilized effectively
Diet & exercise are
employed as the first line of
treatment
If diet & exercise are not
sufficient, oral agents or
insulin may be required
The
exact cause of diabetes is not known
TYPE I DIABETES
Scientists believe that a
genetic predisposition
coupled with
environmental factors
cause the immune system
to attack the pancreas and
destroy the cells that
produce insulin
Most people who have
Type I Diabetes develop
the disease before the age
of 30
TYPE II DIABETES
Though the pancreas continues
to produce insulin, the insulin is
ineffective
Identified risk factors for Type
II Diabetes:
• Obesity (excessive fat prevents
insulin from working properly)
• Specific racial/cultural groups
(African Americans and
Hispanics have a higher
incidence)
• Family History
Diet, exercise, and oral
medications are used for
treatment
Oftentimes, signs
and symptoms of Type I
Diabetes occur suddenly and include:
• Frequent urination (polyuria)
• Increased thirst (polydipsia)
• Rapid weight loss (often in the presence of
increased appetite – polyphagia)
• Irritability
• Nausea & vomiting
The
signs & symptoms of Type II Diabetes
are usually more gradual in onset
In addition to the signs & symptoms
mentioned on the previous slide, the signs &
symptoms of Type II Diabetes may include:
• Hard to heal infections (especially of the skin, gums,
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or bladder)
Vision changes
Tingling or numbness of the distal extremities
Itching
Tiredness
Regular
medical check-ups which
include laboratory monitoring are critical
in detecting abnormally high blood
glucose levels
Physical exams are encouraged annually
by TCLE
The
goal of medication therapy for both
Type I and Type II Diabetes is to maintain
the blood sugar levels within normal
range
Acceptable normal standards are from 70
to 110 mg/dl
In Type I Diabetes, the treatment is to provide
insulin directly to the body
• Insulin is injected under the skin into the fat layer of the
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body
The fatty tissue of the upper arm, thigh, and abdomen are
the usual sites for administration
CMTs required to administer insulin receive special
training from the RN CM/DN before they are authorized to
administer insulin
Small syringes with very thin needles, insulin pens, or
insulin pumps may be used
CMTs are not allowed to calculate the insulin dose. CMTs
may be delegated the task of measuring insulin/filling
the insulin syringe at the discretion of the RN CM/DN
When an individual is diagnosed with Type II
Diabetes, dietary restrictions and an increase in
exercise will be tried to lower blood sugar levels
adequately
If diet and exercise are not effective, oral
hypoglycemic agents will be utilized to lower blood
sugar levels adequately
Oral hypoglycemic agents work by stimulating the
pancreas to increase the production of insulin, by
increasing the effectiveness of the insulin produced,
or by increasing the body’s ability to utilize its own
insulin
If the body does not respond to oral agents, insulin
injections may be required
Unwanted/side
effects of the medications
used to treat diabetes and complications
of the disease requiring emergency
intervention include:
• Hypoglycemia
• Hyperglycemia
• DKA (Diabetic Coma)
Hypoglycemia
(low blood sugar) occurs
more commonly in individuals taking
insulin
Often referred to as insulin shock or
insulin reaction
Hypoglycemic reactions can occur
suddenly
Feeling
shaky
Becoming sweaty
Feeling tired, weak, or nervous
Feeling hungry
Becoming irritable or confused
Developing a headache
Developing a rapid heart rate
It is critical that low blood sugar be treated immediately to
avoid unconsciousness and brain damage
• If the person is conscious, administer a quick acting sugar
by mouth to keep the person from losing consciousness:
1/2 cup of sweetened fruit juice (OJ or Apple)
Hard candy
1/2 cup of regular soda
GlucoTabs
• If the person is unconscious, injecting Glucagon will
stimulate the release of the stored form of glucose,
glucogen, from the liver
911 should be called and the person should be transported to
the nearest emergency room for evaluation and stabilization
CMTs receive individualized training from the delegating
nurse before being authorized to administer glucagon
Hyperglycemia
(high blood sugar)
occurs when the individual’s blood sugar
rises well above the normal range and
stays there—240 mg/dl or higher
Hyperglycemia results from dietary
indiscretions, too little medication,
illnesses, and/or stress
Hyperglycemia often has a slower
pattern of onset
Thirstier
than usual
Hungrier than usual
More frequent urination
Getting up at night to urinate
Dry, itchy skin
More tired than usual
Changes in vision
Infection
Cuts or sores that heal slower than
normal
The
best treatment is prevention
Eat according to the prescribed meal
plan
Take medications as prescribed
Monitor blood sugar levels
Maintain a routine pattern of exercise
If hyperglycemia persists, call the
delegating nurse/Health Care
Professional
DKA
(diabetic coma) is a dangerous
condition that is usually only seen in
Type I diabetics
DKA occurs when an imbalance between
insulin and blood sugar is so out of
control that ketones are produced and
accumulate in the blood
At high levels, ketones are poisonous to
the body
Dry mouth
Excessive thirst
Loss of appetite
Excessive urination
Dry/flushed skin
Labored breathing
Fruity smelling breath (acetone odor)
Vomiting
Abdominal pain
Unconsciousness
If an individual is suspected of having DKA, the
delegating nurse should be contacted and 911
called
It
is important for the individual/care giver
to:
• Inform the delegating nurse of any changes in health
• Know that the individual should wear a medic alert
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bracelet
Observe for signs and symptoms of hypoglycemia
and hyperglycemia, and intervene appropriately
Follow the prescribed diet
Maintain a regular pattern of exercise
Know that the individual should avoid the use of
alcohol
See a podiatrist regularly for foot care
Follow the Nursing Care Plan for foot care
If
you have any questions or concerns
related to Diabetes and our participants,
contact TCLE’s delegating nurse
• 301-373-8100 *821