Nursing -DM

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1. STATISTICS
   1. Life expectancy 5-10 yrs shorter
   2. Cost healthcare system $11.7 billion in 2010
   3. 90% of cases are Type II
   4. Aboriginals: 3-5x higher risk
   5. Worldwide: 285 million people with DM
   6. 80-90% overweight
2. PATHOPHYSIOLOGY
   1. CHANGE IN ADIPOKINES PRODUCTION
      1. Adipokines Alter Glucose & Fat Metabolism
         1. Main Types: Adiponectin & Leptin
   2. HAPHZARD GLUCOSE RESPONSE BY LIVER
      1. Increased Glucagon from α-cells
         1. Stimulates Liver Glucose Production
            1. Increased Blood Sugar
      2. Not a 1° Development Factor
   3. β-CELL ISSUE
      1. β-cells fatigue
         1. Decreased Ability of Pancreas to Produce Insulin
      2. β-cell mass lost
   4. INSULIN RESISTANCE
      1. Issue with GLUT4 Receptors
         1. Unresponsive
            1. Hyperglycemia
         2. Low Numbers
   5. See video: https://www.youtube.com/watch?v=RlLrvnnTDDU
3. ONSET
   1. GRADUAL
      1. Years without Detection
      2. Osmotic Fluid & Electrolyte Loss
         1. Hyperosmolar Coma Risk
4. SIGNS & SYMPTOMS
   1. Type I Sympoms
      1. Polyuria
      2. Polydipsia
      3. Polyphagia
   2. Visual Changes
   3. Fatigue
   4. Prolonged Wound Healing
   5. Recurrent Infection
   6. Increased Hunger
   7. Weight Loss
5. SCREENING
   1. NO RISKS
      1. Every 3 yrs after 40 yrs
   2. RISKS
      1. More frequently
         1. Family Hx
         2. Impaired Fasting Glucose or Tolerance
         3. High-Risk Ethnicity
            1. Aboriginal
            2. Hispanic
            3. South Asian
            4. Asian
            5. African
         4. Hypertension
         5. Overweight
         6. Gestational Diabetes Hx
         7. Sedentary Lifestyle
         8. Metabolic Syndrome
   3. FBG METHOD
6. DIAGNOSIS
   1. HEMAGLOBIN A1C
      1. Recommended by CDA
         1. Check A1C 2-4x a Year
      2. DM: A1C ≥6.5%
         1. Prediabetes: 5.7-6.4%
   2. FASTING PLASMA GLUCOSE
      1. No Caloric Intake for 8 hr
         1. DM: FPG ≥ 7 mmol/L
            1. Prediabetes: 5.6-6.9 mmol/L
   3. RANDOM PLASMA GLUCOSE
      1. DM: ≥ 11.1 mmol/L
      2. Plus Classic Type I Symptoms
   4. ORAL GLUCOSE TOLERANCE TEST
      1. DM: OGIT ≥ 11.1 mmol/L
         1. Prediabetes: 7.8-11.0 mmol/L
7. PREVENTION
   2. Eat a Healthy Diet
      1. Less fat
      2. DASH Diet
   3. Monitor/Lower BP and Cholesterol
8. NURSING ROLE
   1. ASSESSMENT
      1. Past Health Hx
      2. Obesity
      3. Hunger
         1. Weight Loss
      4. Thirst
      5. Poor Healing
   2. PLANNING
      1. Active Participation
      2. Lifestyle Changes
      3. Prevent Chronic Complications
      4. Maintain Normal Blood Glucose Levels
   3. INTERVENTION
      1. Health Promotion
         1. Identification
         2. Monitoring
         3. Patient Education
            1. Especially Foot Care
      2. Stress Management
      3. Caregiver Teaching
   4. EVALUATION
      1. Tx Plan Effectiveness
      2. Patient Knowledge
      3. Nutrition /Activity Balance
      4. Hypoglycemia Management
      5. Safety
9. TREATMENT & MANAGEMENT
   1. HEALTHY EATING
      1. Low Glycemic Index Foods
      2. Less Salt
      3. 20-35g of Fibre/Day
      4. Check Nutrition Labels
      5. Balanced Diet (ie. DASH)
      6. Reduce Caloric Intake
      7. Low-Fat Foods
   2. EXERCISE
      1. Benefits
         1. Increase GLUT4 Rc Sites
         2. Lowers Blood Glucose
         3. Weight Loss
      2. Tips
         1. Before Meals
         2. Individualized
         3. Small Snacks Every 30 min
         4. Monitor BG Before, During, After
   3. DRUG THERAPY (if severe)
      1. Insulin
      2. Oral Agents
         1. 1. Sulphonulureas
            1. 2. Meglitinides
               1. 3. Biguanides
                  1. 4. α-Glucosidase Inhibitors
                     1. 5. Thiazolidinediones
   4. SELF BLOOD SUGAR MONITORING
10. COMPLICATIONS
    1. CHRONIC
       1. Infection
       2. Skin Complications
       3. Lower Extremity/Foot Complications
       4. Diabetic Neuropathy
       5. Macrovascular Angiopathy
       6. Microvascular Angiopathy
    2. ACUTE
       1. Diabetic Ketoacidosis
          1. Profound Insulin Deficiency
             1. More Common in Type I
       2. Hyperosmolar Hyperglycemic Syndrome
          1. Most Common in Type II Over 60 yrs
             1. Life Threatening
       3. Hypoglycemia
          1. Blood Glucose < 4 mmol/L