Post on 14-Jul-2015
Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health -
Diabetes Prevention and Management Initiative
June 2005
Caring for people with
diabetes
Understanding diabetes,
supporting the individual and
planning care
Module 3.2.2
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Presentation purpose
Target audience
Grade 2 nurses, aged care workers and personal care assistants
Aim
To provide best practice care for people with diabetes.
Objectives
Provide an overview of diabetes and how it affects the body.
Discuss what information people with diabetes require in order to understand their condition and appropriate education strategies to provide this information.
Discuss best practice care for people with diabetes.
Discuss role of carers in promoting best practice care.
Discuss guidelines in relation to care planning for diabetes.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Overview of diabetes
Diabetes means that blood glucose in
the body (often called blood sugar) is
too high
Glucose comes from the food we eat
Glucose is transported by the blood
stream to all the cells in the body.
G
G
G
G
G
G
GGG
Muscle
Bloodstream
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Overview of diabetes
Insulin helps the glucose from food get into your cells.
Insulin is a chemical (a hormone) made in a part of the body called the pancreas.
PANCREAS
G
G
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insulin
Muscle
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Overview of diabetes
If your body doesn't make
enough insulin or if the
insulin doesn't work the way
it should, glucose can't get
into cells.
Glucose stays in the blood.
Blood glucose levels get too
high, causing diabetes.
Bloodstream
Muscle
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Common types of diabetes
Type 1 Type 2
Age of onset Usually <40 years Usually >40
years
Body weight Lean Usually obese
Prone to
ketoacidosis
Yes No
Medication Insulin essential Tablets and /or
insulin
Onset of
symptoms
Acute Gradual (may be
asymptomatic)
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Complications of diabetes
Diabetes can cause increased risk of:
Heart Problems
Stroke
Eye sight problems
Kidney problems
Foot problems
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment goals
Symptom free
Prevent short term complications
Prevent long term complications
Quality of life =
Lifestyle focus
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Cornerstones of treatment
Insulin/tablets
Physical activity
Diet
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Healthy eating
To help control blood glucose, blood fats and adequate body weight
Healthy Eating
Regular carbohydrate
High in fibre
Low in fat (particularly saturated fat)
Low in added sugar
Adequate energy /protein/fluids/vits and mins
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Exercise / activity
30 minutes moderate intensity most days
preferably all
Helps to:
Increased insulin sensitivity
Decreased insulin requirements
Weight reduction
Lipid control
Blood pressure control
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Insulin and tablets
Type 2 diabetes treatment may be Healthy eating
Healthy eating + tablets (several different types of tablets may be on combination of tablets
Healthy eating + tablets + insulin
Healthy eating and insulin
Type 1 diabetes always require insulin May have long acting 1-2 times a day
Short and long acting 1-4 times a day
Continuous – insulin pump
Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health -
Diabetes Prevention and Management Initiative
June 2005
Hypoglycaemia
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
What you need to know!
Blood glucose level that is considered low
Signs and symptoms
Causes
Plan of action to treat
Strategies to prevent hypoglycaemia
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Definition of hypoglycaemia
Blood glucose level below 3.5 mmol/L
in people with diabetes who are
treated with insulin or oral
hypoglycaemic agents
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Symptoms
excessive hunger
headache
profuse sweatingfeeling dizzy/shaking
pins and needles
around mouth
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Cognitive impairment
Symptoms of cognitive impairment
Lack of concentrationAltered vision
Peculiar behaviour
Loss of consciousness
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Nocturnal hypoglycemia
Symptoms may include:
Sweating
Vivid dreaming
Restlessness
Incontinence
Waking with a headache
High or low fasting levels
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment
Treat hypoglycaemia with quickly absorbed
glucose (15 gm carbohydrate in total) eg.
100 ml Lucozade
150 ml lemonade
5 Jelly beans
4 Jelly babies
3 heaped teaspoons of sugar
3 glucose tablets
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment
If symptoms have not resolved in 5-10
minutes treatment needs to be
repeated.
Followed up initial treatment with
carbohydrate which is more slowly
absorbed
eg. Sandwich or fruit
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Never
Never give food to an unconscious
person
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment if unconscious
Position in the left lateral position and
withhold any food or fluids. Seek
further medical help.
If glucagon is available it can be
administered subcutaneously,
intramuscularly or intravenously.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Causes of Hypoglycemia
Insufficient food or delayed
meal or snackExcess of
insulin and
some oral
hypogycemic
agents
insulin
Alcohol consumed without food or
excess alcohol
Extra physical activity
or exercise
Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health -
Diabetes Prevention and Management Initiative
June 2005
Hyperglycaemia
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
What you need to know!
What is hyperglycaemia
Causes
Describe the main principles of the
treatment
Diabetic Ketoacidosis
Hyperosmolar non ketotic coma
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Hyperglycaemia
Persistent BGL over 10 mmol/L
Signs and symptoms of hyperglycaemia
Polyuria
Polydipsia
Blurred vision
Weight loss
Infections, thrush
Tired
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Causes of Hyperglycaemia
Increased weight
Incorrect foods or amount of foods
Forgetting or insufficient medication lack
of physical activity
Stress
Certain medications
Illness /infections
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment
Relieve symptoms
Increase monitoring
Identify cause treat accordingly
Observe for signs of concurrent illness or
infection
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Managing Type 2 if illness present
BGLs Monitor 2-4 hourly, record BGLs
Drink 1 glass of fluid per hour If on diet or metformin water or diet lemonade
If on sulfonylureas/insulin - diet or regular
lemonade depending on BGL
Contact Dr If becoming drowsy, vomiting or dehydrated
If BGLs over 15mmol for 24 hours
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Fluids Drink 1 glass of fluid per hour. Sweetened if BGL below 15mmol
- unsweetened if above 15mmmol
Insulin Never omit even if not eating
BGLs Test 2-4 hrly, may require extra short acting insulin
Ketones Test for ketones if ill, BGL > 15 for 24 hours, or if vomiting
Contact Dr If becoming drowsy or dehydrated
If vomiting or ketones present
Managing Type 1 if illness present