Post on 17-Nov-2014
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Diabetes MellitusDiabetes Mellitus (DM): a disease where the
body cannot use glucose normally to meet the energy needs of the body
In people over 65, 1 in 20 require treatmentInsulin is produced in the pancreas. During this
disease process, usually the beta cells of the pancreas cease to function properly.
Two Main Types of Diabetes: Insulin-dependent diabetes mellitus (IDDM) (Type
1) Non-insulin-dependent diabetes mellitus
(NIDDM) (Type 2)
Diabetes MellitusIDDM: In this disease, the beta cells of the pancreas
are damaged and can not produce or don’t produce enough insulin
Insulin is required for the metabolism of glucose
With no insulin, the glucose can not be absorbed by the cells for energy, and accumulates in the bloodstream.
Most often seen in younger people
Diabetes MellitusNIDDM:In this disease, insufficient insulin is
produced or the body ignores the insulinThis results in glucose not being absorbed by
the cells and the glucose accumulating in the blood stream.
Also known as old-age diabetesThis form is more stable than IDDM with
fewer incidents of diabetic coma or insulin shock
Diabetes MellitusSigns and Symptoms:IDDM: Abrupt onsetPolydipsia- excessive thirstPolyuria- excessive urinationPolyphagia- excessive hungerGlycosuria-sugar in the urineHyperglycemia- excessive sugar in the
bloodstream
Diabetes MellitusNIDDM:Patient is usually over weight with a sore or
infection and possibly constant fatigueFatigues easilySkin infections/ slow to healItchingBurning on urinationPain in fingers and toesVision changes
Diabetes MellitusComplications of DM:Renal FailureVision ChangesCardiovascular DamageHyperglycemiaHypoglycemia
Diabetes MellitusRenal Disease:A build up of glucose in the bloodstream
damages all vessels and organs. The crytals are very damagingNote increased itching due to the inability of
the kidneys to remove toxins from the bloodstream
Burning up urination is noted due to the glucose build up in the urine being caustic to the internal organs.
Diabetes MellitusVision ChangesCommon in long term diabetesGlaucoma-increased intraocular pressure
resulting in atrophy of the optic nerveCataracts- an opacity of the lens of the eye usually
occurring as a result of aging, trauma, endocrine or metabolic disease
Retinitis proliferans- inflammation of the retina marked by masses of connective tissue that project from the retina into the vitreous
Blindness-caused by diseases of the lens, the retina or the eye structures; diseases of the optic nerve; or lesions of the visual cortex or pathways of the brain
Diabetes MellitusCardiovascular Damage:Heart AttacksStrokesPeripheral Vascular Disease (PVD)AmputationVascular changes can interfere with the
normal circulation to the legs and feetDamage may be so extensive that the tissues
of the toes, feet, and legs may dieGangrene followed by amputation is common
Diabetes MellitusHyperglycemia- occurs when too little insulin is
available for metabolic needsSugar and acid compounds (ketones) build up in
the blood Known as diabetic ketoacidosis (DKA)Can lead to deathSugar and Ketones can spill over into the urine
First Symptoms:HeadacheConfusionDrowsinessIrritable
Diabetes MellitusTreatment of Hyperglycemia:Immediate tx is insulin and fluids given
intravenously by the nurseReport to the nurse immediately if you notice:Increased thirstComplaints of vision changesComplaints of nausea or vomitingA sweet odor to the breathDry, flushed skin
Diabetes MellitusHypoglycemia-low blood sugar Can be a result of an overdose of insulin
known as Insulin reaction or Insulin ShockCan also be a result of :Not eating enough at the right timeUnusual activitiesVomitingDiarrheaInteraction of medications
Diabetes MellitusSigns and Symptoms:HungerSweatingDizzinessConfusionErratic BehaviorPale moist skinStaggering gaitDrowsiness
Diabetes MellitusTreatment is:Sugar in some formA food containing sugar if the resident is
consciousAn Injection of glucagon if the patient is
unconsciousOrange Juice or other easily absorbed source
of sugar should be kept accessible for emergencies
Finger Stick Blood SugarFingerstick Blood Sugar (FSBS):Used by those with DM to monitor sugar
levels in the bloodUsed to determine dosage requirements of
antidiabetic medicationsResidents who experience emotional stress or
have an infection of any kind are at greater risk for imbalance
Finger Stick Blood SugarFSBS:Is checked by collecting a sample of capillary
blood with a lancetTransferring the blood sample to a regent
stripReading the visual results
Finger Stick Blood SugarThere are many different types of glucometers
(meters used to measure the glucose) availableGlucometers use a test strip in place of the
reagent stripGlucometers will usually give a digital readout
of the glucose levelEach glucometer and its test strips are
different, you will need to know how to properly operate your device before approaching the patient for a sample
Finger Stick Blood SugarFSBS:The MD will order specific times for blood sugar
testing usually before mealsThe MD may also order Two-hour post-prandial
blood sugars (PPBS)- this sample is to be collected exactly two hours after the patient finishes eating
After meals, the blood sugar should be elevated but within two hours after eating, should return to normal
The RN can also instruct you to get a FSBS now, if a patient is displaying S/S of a diabetic upset
Finger Stick Blood SugarNormal Blood Levels:These can vary from facility to facilityThe normal range is usually between 65 and 120Normal value being 70-110Notify the RN immediately if you obtain a value
higher or lower than the normal rangeMost glucometers have a small range. If the value
obtained is below 40 the meter will read “low” and if the value obtained is higher than 500, the meter will read “high”. Report to the RN immediately.
Finger Stick Blood SugarGlucometers:Must be calibrated daily or per facility policyCalibration is done to ensure meter accuracyCalibrating is completed by running a test
using a special test strip or by using a liquid control solution
The results must be within a specified range and must be documented on a log
Do not use a meter until it has been calibrated
Finger Stick Blood SugarProcedure:Equipment:Observe Standard PrecautionsAlcohol swabLancetGlucometerTest Strips for that specific glucometerSharps container
Finger Stick Blood SugarProcedure:Explain the procedure to your patientWipe the patient’s finger with the alcohol
wipe and allow to dryPierce the side of the middle or ring finger
using the lancetPlace the lancet in the sharps containerSqueeze the sides of the finger gently to
obtain a drop of blood
Finger Stick Blood SugarHold the puncture site directly over the reagent
strip and place a hanging drop of blood onto the reagent pad.
Insert the strip into the meter if this was not done previously
Wipe the finger with the alcohol swab and allow to dry.
Apply pressure until bleeding stopsApply bandage if necessaryThe meter should beep with completed with
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