1_1_Nursing -DM

1_1_Nursing -DM

1. STATISTICS

   • Life expectancy 5-10 yrs shorter
   • Cost healthcare system $11.7 billion in 2010
   • 90% of cases are Type II
   • Aboriginals: 3-5x higher risk
   • Worldwide: 285 million people with DM
   • 80-90% overweight

2. PATHOPHYSIOLOGY

   • CHANGE IN ADIPOKINES PRODUCTION
     • Adipokines Alter Glucose & Fat Metabolism
       • Main Types: Adiponectin & Leptin
   • HAPHZARD GLUCOSE RESPONSE BY LIVER
     • Increased Glucagon from α-cells
       • Stimulates Liver Glucose Production
         • Increased Blood Sugar
     • Not a 1° Development Factor
   • β-CELL ISSUE
     • β-cells fatigue
       • Decreased Ability of Pancreas to Produce Insulin
     • β-cell mass lost
   • INSULIN RESISTANCE
     • Issue with GLUT4 Receptors
       • Unresponsive
         • Hyperglycemia
       • Low Numbers
   • See video: https://www.youtube.com/watch?v=RlLrvnnTDDU

3. ONSET

   • GRADUAL
     • Years without Detection
     • Osmotic Fluid & Electrolyte Loss
       • Hyperosmolar Coma Risk

4. SIGNS & SYMPTOMS

   • Type I Sympoms
     • Polyuria
     • Polydipsia
     • Polyphagia
   • Visual Changes
   • Fatigue
   • Prolonged Wound Healing
   • Recurrent Infection
   • Increased Hunger
   • Weight Loss

5. SCREENING

   • NO RISKS
     • Every 3 yrs after 40 yrs
   • RISKS
     • More frequently
       • Family Hx
       • Impaired Fasting Glucose or Tolerance
       • High-Risk Ethnicity
         • Aboriginal
         • Hispanic
         • South Asian
         • Asian
         • African
       • Hypertension
       • Overweight
       • Gestational Diabetes Hx
       • Sedentary Lifestyle
       • Metabolic Syndrome
   • FBG METHOD

6. DIAGNOSIS

   • HEMAGLOBIN A1C
     • Recommended by CDA
       • Check A1C 2-4x a Year
     • DM: A1C ≥6.5%
       • Prediabetes: 5.7-6.4%
   • FASTING PLASMA GLUCOSE
     • No Caloric Intake for 8 hr
       • DM: FPG ≥ 7 mmol/L
         • Prediabetes: 5.6-6.9 mmol/L
   • RANDOM PLASMA GLUCOSE
     • DM: ≥ 11.1 mmol/L
     • Plus Classic Type I Symptoms
   • ORAL GLUCOSE TOLERANCE TEST
     • DM: OGIT ≥ 11.1 mmol/L
       • Prediabetes: 7.8-11.0 mmol/L

7. PREVENTION

   • Eat a Healthy Diet
     • Less fat
     • DASH Diet
   • Monitor/Lower BP and Cholesterol

8. NURSING ROLE

   • ASSESSMENT
     • Past Health Hx
     • Obesity
     • Hunger
       • Weight Loss
     • Thirst
     • Poor Healing
   • PLANNING
     • Active Participation
     • Lifestyle Changes
     • Prevent Chronic Complications
     • Maintain Normal Blood Glucose Levels
   • INTERVENTION
     • Health Promotion
       • Identification
       • Monitoring
       • Patient Education
         • Especially Foot Care
     • Stress Management
     • Caregiver Teaching
   • EVALUATION
     • Tx Plan Effectiveness
     • Patient Knowledge
     • Nutrition /Activity Balance
     • Hypoglycemia Management
     • Safety

9. TREATMENT & MANAGEMENT

   • HEALTHY EATING
     • Low Glycemic Index Foods
     • Less Salt
     • 20-35g of Fibre/Day
     • Check Nutrition Labels
     • Balanced Diet (ie. DASH)
     • Reduce Caloric Intake
     • Low-Fat Foods
   • EXERCISE
     • Benefits
       • Increase GLUT4 Rc Sites
       • Lowers Blood Glucose
       • Weight Loss
     • Tips
       • Before Meals
       • Individualized
       • Small Snacks Every 30 min
       • Monitor BG Before, During, After
   • DRUG THERAPY (if severe)
     • Insulin
     • Oral Agents
       • 1. Sulphonulureas
         • 2. Meglitinides
           • 3. Biguanides
             • 4. α-Glucosidase Inhibitors
               • 5. Thiazolidinediones
   • SELF BLOOD SUGAR MONITORING

10. COMPLICATIONS

    • CHRONIC
      • Infection
      • Skin Complications
      • Lower Extremity/Foot Complications
      • Diabetic Neuropathy
      • Macrovascular Angiopathy
      • Microvascular Angiopathy
    • ACUTE
      • Diabetic Ketoacidosis
        • Profound Insulin Deficiency
          • More Common in Type I
      • Hyperosmolar Hyperglycemic Syndrome
        • Most Common in Type II Over 60 yrs
          • Life Threatening
      • Hypoglycemia
        • Blood Glucose < 4 mmol/L

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