Diabetes

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.


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



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

GG

insulin

Muscle



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


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)


Complications of diabetes

Diabetes can cause increased risk of:

Heart Problems

Stroke

Eye sight problems

Kidney problems

Foot problems


Treatment goals

Symptom free

Prevent short term complications

Prevent long term complications

Quality of life =

Lifestyle focus


Cornerstones of treatment

Insulin/tablets

Physical activity

Diet


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


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


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




June 2005

Hypoglycaemia


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


Definition of hypoglycaemia

Blood glucose level below 3.5 mmol/L

in people with diabetes who are

treated with insulin or oral

hypoglycaemic agents


Symptoms

excessive hunger

headache

profuse sweatingfeeling dizzy/shaking

pins and needles

around mouth


Cognitive impairment

Symptoms of cognitive impairment

Lack of concentrationAltered vision

Peculiar behaviour

Loss of consciousness


Nocturnal hypoglycemia

Symptoms may include:

Sweating

Vivid dreaming

Restlessness

Incontinence

Waking with a headache

High or low fasting levels


Act quickly


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


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


Never

Never give food to an unconscious

person


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.


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




June 2005

Hyperglycaemia


What you need to know!

What is hyperglycaemia

Causes

Describe the main principles of the

treatment

Diabetic Ketoacidosis

Hyperosmolar non ketotic coma


Hyperglycaemia

Persistent BGL over 10 mmol/L

Signs and symptoms of hyperglycaemia

Polyuria

Polydipsia

Blurred vision

Weight loss

Infections, thrush

Tired


Causes of Hyperglycaemia

Increased weight

Incorrect foods or amount of foods

Forgetting or insufficient medication lack

of physical activity

Stress

Certain medications

Illness /infections


Treatment

Relieve symptoms

Increase monitoring

Identify cause treat accordingly

Observe for signs of concurrent illness or

infection


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


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

Diabetes

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