Diabetes Mellitus: Management of Diabetes
Authored by: Virginia G. Miller, PhD, RN, CS, FNP
Contact Hours: Valid for 7.0 (ANCC) and 8.4 (ABN) contact hours valid July 21, 2016 through July 21,
2018
Target Audience: Registered Nurses and Licensed Practical Nurses
Purpose/Goal: The purpose of this activity is to provide a comprehensive review of Diabetes Mellitus
Objectives: At the conclusion of this activity the learner should be able to:
1. List the 4 cornerstones of Diabetes and its effect on blood glucose. 2. Describe the treatment algorithms for management of Diabetes Mellitus Type 2. 3. Relate an appropriate teaching plan. 4. Describe recommended monitoring & possible complications. 5. Review current research about Diabetes.
Fees: ASNA Member - $55.00 Non-Member - $75.00
Instructions for Credit: Participants should read the purpose/goal and objectives and then study the
activity on-line or printed out. Read, complete, and submit answers to the post-test at the end of the activity.
Participants must achieve at least 80% on the post-test, complete the evaluation and submit the appropriate
fee to receive continuing education credit. Print out the Post-test and evaluation and return the completed
sheets to the Alabama State Nurses Association (ASNA) to receive a Certificate of Completion. The Post-
test and evaluation sheet may be mailed or faxed to ASNA.
Disclosures: The author and Planning Committee have declared not conflict of interest.
Certificates: Certificates of Completion will be emailed/mailed within 2 weeks Hours will be reported
to the ABN within 2 weeks of certificate.
Accreditation: The Alabama State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centers Commission on Accreditation.
Alabama Board of Nursing Provider Number ABNP0002 (valid through March 30, 2017).
Alabama State Nurses Association
360 N. Hull St.
Montgomery, AL 36104
Fax: 334-262-8578
2
DIABETES MELLITUS: MANAGEMENT OF DIABETES
HOME STUDY PROGRAM
2014 VIRGINIA G. MILLER, PHD, RN, FNP-BC
3
DIABETES MELLITUS: MANAGEMENT OF DIABETES
HOME STUDY PROGRAM
2014 VIRGINIA G. MILLER, PHD, RN, FNP-BC
INTRODUCTION TO THE HOME STUDY COURSE
This Home Study Program provides information about the management of diabetes mellitus.
Since the disorder has plagued the human race for an extremely long time (perhaps, forever),
treatment methods have varied greatly. From near-starvation diets in the days before insulin was
discovered (which only prolonged the inevitability of death) to today's multi-faceted treatments
based on scientific research and a much clearer understanding of the underlying pathophysiology
of diabetes, the management of diabetes is continually being refined.
In addition to management issues, topics of recent research are discussed. A glossary of terms is
provided as is Appendix D which lists behavioral objectives for an education plan for persons
with diabetes and their significant others. The objectives may be used as a model for an
individualized education plan for others. "Learner Activities" are included where appropriate to
provide experiential learning. A current and comprehensive reference list is also provided.
PROCESS OF THE COURSE
It is recommended that the learner review the post-test first to determine what is already
understood about the management of diabetes and what needs to be learned. Afterward, the
learner should read the content and participate in the "Learner Activities" included in the
program. Then, the post-test should be completed. Last, the learner is asked to complete the
evaluation form. In the past, improvements in the course have been made, in part, on the basis of
this feedback, so the author is asking each learner to provide constructive feedback both
positive and negative.
4
DIABETES MELLITUS: MANAGEMENT OF DIABETES
HOME STUDY PROGRAM
TABLE OF CONTENTS
PAGES
INTRODUCTION 6
Management of Diabetes An Overview 6
UNIT I CONTROL OF DIABETES FOUR "CORNERSTONES" 7
The First Cornerstone of Treatment -- Nutrition Therapy/Eating Patterns 7
The Second Cornerstone of Treatment Exercise 9
The Third Cornerstone of Treatment Medication 11
The Fourth Cornerstone of Treatment Self-Monitoring of Blood Glucose 19
(SMBG)
UNIT II EVIDENCE-BASED GUIDELINES FOR THE MANAGEMENT 20
OF DIABETES
Treatment Algorithms for Management of Diabetes Mellitus Type 2 (DMT2) 20
Texas Diabetes Council (2012-B) -- Treatment Algorithms for Management of Diabetes 21
Clinical Goals for Blood Pressure and Lipids Recommended by the American Diabetes 21
Association
UNIT III PATIENT EDUCATION 23
Assessment of the Emotional State of the Patient 23
Readiness to Learn 25
Teaching Plan 25
Current Concepts of Diabetes Control 25
Glycemic Goals for Many Non-Pregnant Adults with Diabetes 26
The American Diabetes Association's Recommended Goals for Blood 26
Glucose and A1c for Type 1 Diabetes by Age-Group
Managing Diabetes During Pregnancy 27
UNIT IV: MONITORING AND COMPLICATIONS 28
Introduction 28
Recommended Monitoring Techniques for Control and Possible Prevention of 29
Complications
Recommended Immunizations 31
The Cost of Diabetes Control in Dollars and Cents 32
Complications Overview 33
5
Complications Acute 34
Complications Long-Term 39
Diabetes Care During Common Illnesses 41
UNIT V: CURRENT RESEARCH 42
Research About Causes of Diabetes 42
Research About Preventing DMT1 42
Research About Preventing DMT2 44
Research About Ways to Provide Effective Control and 45
New Ways of Administering Insulin
The Life (and Death) of What Had Been a New Way to Take Insulin 47
Research Reported at the 73rd Scientific Sessions of the American 48
Diabetes Association That Occurred 6/21/13-6/25/13 in Chicago, IL
Research about Noninvasive and Continuous Blood Glucose Monitors 48
Research about Transplantations: Pancreas, Islet Cells 48
Research about the Use of Aspirin by People with Diabetes as a 50
Prevention Strategy for Cardiovascular Disease
Other Resources for Learning About Diabetes Research 51
REFERENCES 52
RESOURCES 58
GLOSSARY 60
APPENDIX A Modified Exchange Lists 63
APPENDIX B Summary of Drugs (Other than Insulin) Used to Treat DMT2 66
APPENDIX C Insulin Characteristics According to Type 70
APPENDIX D -- Behavioral Objectives to Plan Teaching for and/or to Evaluate 71
Learning by the Patient with Diabetes
1
INTRODUCTION
Management of Diabetes An Overview
As stated previously, the management of diabetes has evolved over the years. Since the earliest
recorded statements about the disorder in 1552 BCE by Hesy-Ra, an Egyptian physician who
wrote, in the Ebers Papyrus, remedies he had developed to address what was described as "the
passing of too much urine" (Canadian Diabetes Association, 2012). The first recorded treatment
of diabetes occurred in 1797 and was described by the Scottish physician, John Rollo as "an
animal diet" consisting of "plain blood puddings" and of "fat and rancid meat" (Canadian
Diabetes Association, 2012).
With the discovery of insulin in 1921, lives were saved. Eli Lilly and Company responded to the
loud clamoring for insulin with the mass production of it in 1922.
For many years, insulin was the only drug used to treat diabetes. Soon, however, an awareness
that two types of diabetes afflicted people the "original" type in which individuals produced no
insulin victims were typically children and another type in which individuals seemed to be
resistant to insulin victims were typically adults. These were later labeled "Juvenile-Onset
Diabetes"* and "Adult-Onset Diabetes"** respectively. Whereas insulin "worked" for both types
of diabetes, the amounts required to control the blood glucose in the latter group were
significantly greater than the amounts required to control the blood glucose of those with DMT1.
The discovery of sulfonylureas the first oral agents used to treat DMT2 was serendipitous to
the use of sulfonamide antibiotics in the treatment of typhoid fever in 1942. Some patients taking
these drugs were found to experience severe hypoglycemia. After considerable research,
stimulation of insulin secretion by these drugs was confirmed, and the first sulfonylureas were
used to treat DMT2 in 1955 (Henquin, 2004). While insulin remains the primary treatment for
DMT1, from 1955 until present time many other medications have been developed both oral
and injectable to treat DMT2.
Management of diabetes has a primary goal to achieve an A1c value of < 7% without severe
hypoglycemic episodes. Along w/ this go
