Pickaway-Ross Medical Careers II Pickaway-Ross Medical Careers II

Diabetes MellitusDiabetes Mellitus

Symptoms, Treatment, Crisis

&Measuring Blood Glucose Levels

Key TermsKey Terms

Diabetes Mellitus (sugar diabetes) is a disease in which the body cannot produce or use insulin properly.

Insulin is a hormone produced by the pancreas thatallows the glucose in the blood stream to enter intocells to be used as energy.

ObjectivesObjectives Distinguish between the types of diabetes mellitus. Identify signs and symptoms of diabetes mellitus. Describe risk factors for diabetes mellitus. Explain the complications of diabetes mellitus Discuss treatment of diabetes mellitus. Recognize the signs and symptoms hypo and

hyperglycemia Identify nurse aide actions to treat hypo and

hyperglycemia . Demonstrate blood glucose monitoring procedure. Measure and document accurate blood glucose. Employ standard of care for diabetic clients

Diabetes Mellitus: TypesDiabetes Mellitus: TypesNamed according to age of onset & need for insulinType I

Usually occurs early in life (children, teens, & young adults)

Rapid OnsetPancreas produces little or no insulinInsulin dependentMore severe Higher risk of complications•Live longer with disease

Diabetes Mellitus: TypesDiabetes Mellitus: TypesType II (Non-insulin dependent)

Adult-onset; typically obeseCan occur at any ageSlow onsetControlled with diet and/or oral medications that stimulate the pancreas to secrete insulin Can become insulin dependent (Type I)

Gestational Diabetes Diabetes develops during pregnancyTypically goes away after pregnancyHigher risk for Type II later in life

Signs & SymptomsSigns & Symptoms1. Excessive thirst (polydipsia)2. Excessive urination (polyuria)3. Increased frequency in eating (polyphagia)4. Recent loss of weight (without trying/dieting)5. Delayed healing in wounds6.Dry, itchy skin7.Losing feeling or tingling in the feet8.Blurred vision9.Fatigue

Risk FactorsRisk FactorsFamily History of the diseaseType I

WhitesType II

OlderOverweightAfrican-AmericanNative AmericansHispanics

ComplicationsComplications

•Blindness•Kidney damage/renal failure•Nerve damage•Damage to gums and teeth•Heart & blood vessel disease from fatty deposits•Foot & leg wounds & ulcers

•Infection & gangrene•Amputation

TreatmentTreatmentGoal: Control of diet, exercise and medication. Type I

Daily insulin therapyHealthy eatingExercise

Type II Healthy eatingExerciseOral medications

Compliance by the patient and regular glucose monitoring help keep the balance of treatment.

InsulinInsulinGiven as a subcutaneous injection by RN, allows the body to use glucose

Types of insulin - long lasting or short acting

Insulin injections are timed to peak during meal time and after meals

A patient may receive several types of insulin

Blood sugars regulate the amount of insulin orderedNormal blood sugar levels: 70 - 110 mg/dl

Hyperglycemia: High Blood SugarHyperglycemia: High Blood SugarToo much food, too little insulin, stress or illnessUndiagnosed DiabetesOnset may be gradual Symptoms 1. Extreme thirst/dry mouth 2. Frequent urination 3. Dry skin 4. Hunger 5. Blurred vision 6. Drowsiness 7. NauseaCan progress to DIABETIC COMA

Hyperglycemia: Diabetic ComaHyperglycemia: Diabetic ComaKetoacidosis (DKA)Blood sugar - 250 mg/dl or above Symptoms

1. Extreme dry mouth/thirst 2. Sweet or fruity odor to the breath (Juicy Fruit) 3. Nausea and/or vomiting 4. Weakness or dizziness

5. Confusion 6. Rapid, deep respirations

7. Drowsiness 8. Dry, flushed skinEventually lose consciousness/die without tx

Hyperglycemia: Diabetic ComaHyperglycemia: Diabetic ComaTreatment

Place in a position of comfortMonitor respirationsNeed immediate medical treatment•Fluid Replacement•Electrolyte Replacement•Insulin Therapy

Hypoglycemia - Low Blood SugarHypoglycemia - Low Blood SugarFailure to eat proper amounts, vomiting after taking insulin, or taking excess insulinSudden onset Symptoms

1. Hunger2. Fatigue; weakness3. Trembling; shaking4. Sweating5. Headache6. Dizziness; feeling faint

Can progress to INSULIN SHOCK

Hypoglycemia – Insulin ShockHypoglycemia – Insulin Shock Blood sugar - 60 mg/dl or belowSymptoms

1. Behavior change2. Confusion3. Clumsy and jerky4. Restless, anxious5. Palpitations6. Rapid pulse7. Low blood pressure8. Convulsions

Eventually lose consciousness/brain damage/death

Hypoglycemia – Insulin ShockHypoglycemia – Insulin Shock Treatment

Restore blood sugar levels to normal ASAPConscious•Drink fruit juice or sugared (not diet) soda•Eat sugar in form of candy, cubes or tablets

Unconscious•Requires immediate emergency care•Glucagon injection

1.

Specimen Collection - PlanSpecimen Collection - PlanStandard precautionsRequired prerequisites for test i.e., fastingOrganization of equipment

Specimen Collection - ProcedureSpecimen Collection - Procedure1. Correct patient2. Explanation & teaching (patient & family) - provide clear explanations3. Prepare client and environment4. Obtain specimen

Right patient Right amount of specimen Right time

General GuidelinesGeneral GuidelinesUnderstand that collection of specimen may cause anxiety, embarrassment, or discomfortProvide support for the patientChildren may benefit from support from parents or care providers during specimen collectionAseptic technique for collection of all specimensKnow facilities policies and proceduresBe aware of deviations from normal values that

may occur as a result of certain medications or diet

Understand the expense of lab tests

Glucose TestingGlucose TestingGlucose testing may be done by urine or bloodBlood testing more accurate & has replaced urineFrequency- ordered by physician 1. Fasting 2. 30 minutes prior to meals (AC) 3. 2 hours after meals (PC) 4. Bedtime (HS)

Glucose TestingGlucose TestingBlood Tests:

1. Venipuncture2. Capillary blood by skin puncture

Capillary blood is desirable:When venipuncture cannot be performedWhen reducing the frequency of needle sticks

in desired & less painful

Measuring Blood GlucoseMeasuring Blood GlucoseThe ease of a skin puncture makes the procedure

possible for patients to perform at home Skin puncture performed by a hand held lancet or

an automatic lancet device Self-testing can be performed by two methods:

1. Reading a reagent strip 2. Use of a reflectance meter (Accucheck) Both methods require a large drop of blood Follow manufacturer’s instructions

Finger Stick SitesFinger Stick Sites

Sites for skin punctures: finger tips, ear lobes, and heels (infants)

Finger tips most common Avoid sites that are swollen, bruised, cyanotic,

scarred, or calloused (poor blood flow) Callouses are frequent on the thumb & index finger Preferred fingers - middle & ring finger Use the side of finger

Finger Stick SitesFinger Stick Sites

Performing Skin PuncturePerforming Skin PunctureStandard precautionsHave patient wash hands & position comfortablyAssemble equipment & open lancet or lancet device & alcohol wipesCalibrate meter according to instructionsDonn clean glovesInspect patient’s fingersWarm site if cold (rub or apply warm wash cloth)

Performing Skin PuncturePerforming Skin Puncture

Hold finger with thumb and forefinger in a dependent position & massage gently toward puncture siteClean site with alcohol (allow site to dry)Place lancet device against side of finger & push release button (hold lancet perpendicular to site & pierce site in one continuous movement)

Performing Skin PuncturePerforming Skin Puncture

Wipe away first drop of blood First drop usually contains a large amount of

serous fluidLightly squeeze site to allow a large drop of blood

to form

Blood Glucose TestBlood Glucose TestReagent strip - Check strips for expired dates;

place large drop of blood on strip and time according to instructions

Glucose meter:Be sure meter is calibrated properly (coding)Perform control testing according to policyPlace large drop of blood on reagent stripPress meter timer (many machines have

automatic timers)Apply pressure to site until bleeding stops

Discard lancet in sharps container

Urine Testing for GlucoseUrine Testing for Glucose Easy to perform and painless Double-voided specimen for best results Certain medications can cause false positives i.e., tetracyclines, sulfonamides, ascorbic acid Dip reagent strip (check for expired dates) into

urine. Compare to color chart, reading at designated time Follow manufacture instructions

DocumentationDocumentationReport results to RN immediatelyDocument (diabetic flow record)

Time specimen was collectedSite usedTest resultsPatient tolerance of procedureOther observations or patient complaints

Care of Diabetic PatientsCare of Diabetic PatientsThe Patient Care Assistant:

•Accurate recording of vital signs•Blood tests performed as ordered•Accurate bedside testing•Dietary trays delivered on time•Correct diet & correct food•Accurate I&O•Notify RN if patient does not eat, NPO for tests, observation of signs & symptoms, patient complaints, test results