An introduction to diabetes

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Aims To give an overview of Type 1 and Type 2 diabetes To give information on what normal blood glucose levels

should be Discuss hypo and hyper glycaemia To identify the complications associated with diabetes To give information on the different types of medication To instruct how to monitor blood glucose levels

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Objectives The Health Care Assistant will understand the differences

between Type 1 and Type 2 Diabetes The HCA will know what normal blood glucose levels

should be The HCA will know what the complications associated

with diabetes are The HCA will understand what medications are used in

diabetic control The HCA will be able to monitor blood glucose level and

support the diabetic patient

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What is diabetes? Diabetes mellitus is a common condition in which the

amount of glucose in the blood is too high because the body is unable to use it properly

It can occur at any age but incidence increases with age The hormone called insulin controls the amount of

glucose in the blood Insulin is made in a gland called the pancreas

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What is diabetes? Food is digested and particularly sugary and starchy

foods are turned into glucose

Glucose travels round the body in the blood

Glucose is used for energy

Insulin moves the glucose from the blood into the cells

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Food and Insulin Food is taken in and

travels through the gut The pancreas secretes

insulin when we eat Food is broken into

smaller molecules in the gut

Some of these are GLUCOSE

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What is diabetes? After a meal blood glucose levels rise and insulin is

normally released into the blood

Insulin is crucial to stop blood glucose levels rising too high

Diabetes develops when the pancreas is unable to produce insulin or when cells cannot use the insulin properly

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How the glucose gets into the cells

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What is normal blood glucose?

The aim is to restore blood glucose levels towards normal limits

General aim 4 – 7mmols before foodHypoglycaemia (low blood sugar) is when blood glucose falls below 4mmols

Blood glucose levels fluctuate throughout the day. However persistently high or low readings need reviewing

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Two types of diabetes Type 1 Develops when there is a severe lack of insulin

in the body because most or all insulin producing beta cells in the pancreas have been destroyed. This is treated by insulin injections and diet

Type 2 Develops when pancreas still produces insulin but there is cellular resistance and insulin cannot be used properly by the body. This is treated by diet alone or diet and tablets, or diet and insulin injections (Tortora and Grabowski 1996)

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Type 1 Type 2

Age of onset Young <40yr Older >40yr

Symptoms Yes -very sudden/intense

Sometimes -slow gradual onset

Auto immune Yes No

Producing own insulin

No Yes

Body Weight Normal Normal/overweight

Treatment Insulin Diet/tablets/Insulin

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Treatment of diabetesDiet (healthy eating) and lifestyle interventionsOral hypoglycaemic agentsInjectables (Exenatide & Liraglutide)Insulin & oral hypoglycaemic agentsInsulin

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Factors affecting glycaemic levels

Diet (amount,type and frequency of food)AlcoholExercise levelsStress/emotional upsetIllness/infectionPregnancy

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Things which lower blood glucose

Insulin injectionsDiabetes tabletsExerciseForgetting a meal or eating too little

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Things which will raise blood glucose

Over-eating, particularly starchy or sugary foodMissing an insulin injectionForgetting a tabletIllness/infectionStress

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HypoglycaemiaCauses

Too much insulinToo many ‘Diabetic’ tabletsNot enough food or delayed food intakeIncreased exerciseExtremes of weatherAlcoholEarly Pregnancy

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Hypoglycaemia(below 4 mmol/l) signs and symptoms

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Hypoglycaemia (below 4 mmol/l) signs and symptoms

Sweating Shaking Headaches Blurred vision Dizziness Tingling lips/fingers/tongue Palpitations Feeling hungry Lack of concentration Pallor Glazed eyes Personality changes/behavioural changes

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Hypoglycaemia Treatment

Group Activity

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Hypoglycaemia Treatment

Quick acting Sugar Glucose Sweets (2-3 sweets) Lucozade (small glass) Orange Juice (small glass) Sugar (2-3 spoonfuls)

Followed up with longer acting carbohydrate snack

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HypoglycaemiaTreatment continued

If patient is resisting food can try Glucogel (formerly Hypostop) if available

If unable to swallow/drowsy may use Glycogen if available

If unconscious will need 999 call

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Hyperglycaemia signs and symptoms

Group Activity

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Hyperglycaemia signs and symptoms Thirst Tiredness Polyuria (frequency passing urine particularly at night) Weight loss Fast breathing Vomiting – late stages Impaired consciousness Increased risk of infections (in particular thrush)

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TreatmentReview patient and medicationSick day rules

○ Seek medical advice if vomiting or getting worse○ Give plenty of fluids○ If not eating, replace food with drinks○ i.e. lucozade / lemonade – small glass○ Don’t stop insulin / tablets○ Monitor closely

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Dietary Guidelines

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The Main TabletsTablets that help the body to use insulin more effectively – metformin - usually used in overweight people – affects the stomach

Tablets that stimulate the pancreas to produce more insulin – gliclazide - can cause low blood sugar

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Additional TabletsLess commonly usedPost prandial glucose regulators- glinidesGlitazones Sitagliptin / Vitagliptin / Saxagliptin (Relatively new)

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New Options Dipeptidyl Peptidase 4

Inhibitors

(DPP-4, Gliptins)○ Sitagliptin○ Vildagliptin○ Saxigliptin

Glucagon-Like Peptide –1 (GLP-1)

○ Exenatide – Byetta ○ Liraglutide – Victoza

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InjectablesFor people with Type 2 diabetes not to be used in Type 1 diabetes

Exenatide – twice a day or a once weekly option Liraglutide – once a day

Both to be used in combination with tablets and are subcutaneous injections.

These are not INSULIN

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InsulinOnce daily – long acting – can be used in type 2

Twice daily – medium acting – can be used in type 2

Four times daily – one long acting and three short acting with meals

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Insulin and Tablets Importance of taking these at the correct time

Why do we say this?

Insulin and some tablets work with food

If given at the wrong time can cause○ Low blood sugar○ High blood sugar

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Complications of diabetesEye damageDiabetic Retinopathy (bleeding at the back of the eye & formation of new vessels)

If untreated can lead to blindness

People with diabetes need to have annual screening for early signs of eye damage

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Retinopathy

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Retinopathy

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Complications of DiabetesKidney damage

Diabetic Nephropathy (formation of small new blood vessels in the kidneys)

Undetected can lead to renal failurePeople with diabetes need to have good control of their blood pressure & blood sugar levels to reduce the risk of developing these problems

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Kidneys – renal disease

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Complications of DiabetesIncreased risk of Heart Disease & Stroke Build up of cholesterol (fatty deposits) on the linings of

the blood vessels restrict the flow of blood through the vessels which can lead to heart attack & strokes

To reduce the risk No smoking Good control of blood pressure & cholesterol Maintain normal weight Low fat diet Regular exercise

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Heart Disease and Strokes

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Complications of DiabetesFoot problems Diabetic Neuropathy, damage to the nerve supply to the feet Affect blood supply to the legs & feet Leading to reduced/slow healing of any injuries Risk can be reduced by maintain good diabetes control and good

foot care

Report any cuts, sores, abnormal looking areas straight away – this may save the person’s foot

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Feet-Circulation, sensation and ulcers

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Monitoring Control

Practical sessionHow to take a blood glucose measurementCompleting blood glucose diary Documentation (including prescription charts) Safe disposal of sharps

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Procedure

Identify patient, obtain consent and cooperation Wash and dry your hands and apply gloves Ensure that patient has washed hands in warm soapy

water, rinsed and dried completely Carefully remove test strip from packaging Insert test strip into meter and ensure meter coded Use Unilet lancing device and puncture finger on side of

fingertip (outer aspect) avoiding thumb and forefinger Gently squeeze/massage fingertip to get

round drop of blood

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If blood smears do not use this sample. Dry the area and gently squeeze another drop of blood. If still not effective, puncture a new site with a new lancet

Apply sample as per manufacturers instructions Press cotton wool or gauze to puncture site Dispose of used lancet and test strip in sharps bin Remove gloves and wash hands with soap & water Record BM result in patients notes If BM result out of target range,

act accordingly & seek advice

From Qualified Nurse or GP

Quiz EVALUATION