CARE FOR
THE
CLIENT
WITH

• Classic clinical manifestations of all types of diabetes include the “three Ps”:
• Polyuria
•
• Polydypsia
• Polyphagia
Other symptoms include:
• Fatigue and weakness
• Dry skin
• Sudden vision changes
• Tingling or numbness in hands or feet
• Skin lesions or wounds that are slow to heal and recurrent infections.
• Type 1 diabetes may be associated with sudden weight loss or nausea, vomiting, abdominal pains if DKA has developed.

• CRITERIA FOR THE DIAGNOSIS OF DIABETES
• American Diabetes Association (ADA, 2004)-Diagnostic criteria for Diabetes Mellitus
1. Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200 mg/dL (11.1 mmol/L). Casual is defines as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydypsia, polyphagia and unexplained weight loss.
or
2. Fasting Plasma Glucose (FPG) or Fasting Blood Sugar (FBS) greater than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for atleast 8 hours.

or
3. Two-hour postload glucose equal to or greater than 200 mg/dL (11.1 mmol/dL) during an oral glucose tolerance test. The test should be performed as described by the World Health
Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.
4. In the absence of unequivocal hyperglycemia with acute metabolic decompensation, these criteria should be confirmed by repeat testing on a different day. The third measure is not recommended for routine clinical use.

• ABNORMAL LABORATORY VALUE FOR
GLUCOSE
• Fasting Plasma Glucose (FPG) or Fasting
Blood Sugar(FBS)
• 126 mg/dL (7.0 mmol/L) above
• Random Plasma Glucose (RPG) or Random
Blood Sugar (RBS)
• 200 mg/dL (1.1 mmol/L) above
• NORMAL LABORATORY VALUE FOR
GLUCOSE
• Glucose, Fasting: 70-110 mg/Dl
• Glucose, monitoring: 60-110 mg/dL
• Glucose, 2-hr postprandial: < 140 mg/dL

• Five components in Diabetes management:
1. Nutritional therapy
2. Exercise
3. Monitoring
4. Pharmacologic therapy
5. Education

 Meal Planning and Related Teaching o Caloric requirements o Caloric distribution
 Carbohydrates
 Fats
 fiber
 Other Dietary Concerns o Alcohol consumption o Sweeteners o Misleading Food Labels

 General Precautions for Exercise in
People With Diabetes
• Use proper footwear and, if appropriate, other protective equipment.
• Avoid exercise in extreme heat or cold.
• Inspect feet daily after exercise.
• Avoid exercise during periods of poor metabolic control.

• Self-Monitoring of Blood Glucose
• Continuous Glucose Monitoring
System
• Glycated Hemoglobin
• Urine Glucose Testing
• Testing for Ketones

• Insulin Therapy and Insulin
Preparations
• Insulin Regimens
Two general approaches to insulin therapy:
- Conventional Regimen
- Intensive Regimens

• Insulin Regimens
Two general approaches to insulin therapy:
- Conventional Regimen
- Intensive Regimens
• Complications of Insulin Therapy
- Local Allergic Reactions
- Systemic Allergic Reactions
- Insulin Lipodystrophy
- Resistance to Injected Insulin
- Morning Hyperglycemia
• Alternative Methods of Insulin Delivery
- Insulin Pens
- Jet Injectors
- Insulin Pumps
- Implantable and Inhalant Insulin
Delivery
- Transplantation of Pancreatic Cells

• Sulfonylureas
• Non-sulfonylureas
• Biguanides
• Alpha-glucosidase inhibitors
• Thiazolidinediones
 Other pharmacologic therapy
• Pramlintide (Symlin)
• Exanatide (Byetta)

 Patient Education
 Developing a Diabetic Teaching Plan o Organizing Information o Assessing Readiness to Learn o Determining Teaching Methods
 Implementing the Plan o Teaching Experienced Patients o Teaching Patients to Self-Administer
Insulin
- Storing Insulin
- Selecting Syringes
- Preparing the Injection: Mixing Insulins
- Withdrawing Insulin

- Selecting and Rotating the Injection Site
- Preparing the Skin
- Inserting the Needle
- Disposing of Syringes and Needles
• Promoting Home and Community-Based
Care
- Teaching Patients Self-Care.
- Continuing Care