CELLULAR REGULATION:
DIABETES
NUR113
R. Willis, DNP, RN
11.3% of the U.S. population has diabetes
1 in 5 are undiagnosed
38% of the population has pre-diabetes
13.9% of Alabama adults report diabetes diagnosis
Particularly problematic in Black Belt Region
A diabetes diagnosis adds over $9,000 to annual medical expenses
DIABETES
BY THE NUMBERS
https://diabetes.org/about -us/statistics/cost -diabetes
https://www.alabamapubl ichealth.gov/healthrankings/diabetes.html
https://www.cdc.gov/diabetes/data/statistics -report/diagnosed -diabetes.html
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ALABAMA
AND
DIABETES
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SYSTEMS
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Group of metabolic diseases
characterized by increased
levels of glucose in blood
NOT JUST A “SUGAR” ISSUE
Problems:
Insulin Secretion
Insulin Action
Both
Insulin and Glucagon: Working in Unison
GLUCAGON
Insulin
INSULIN
Blood
Sugar
INSULIN
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Insulin
Transports ___________ into the cell for energy
Stimulates storage of __________ in the liver and muscle as __________
Stops the _________from releasing glucose
Enhances storage of fat in _________ tissue
Inhibits breakdown of stored ____________, protein, and ________
Promotes movement of the __________electrolyte into the cell
Secreted by the ______ cells in the _________
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https://slideplayer.com/slide/6962599/
Glucagon
Secreted by the _________ cells in the _______
Stimulates the ___________ to release stored
__________ when blood sugar is ________.
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https://www.endocrineweb.com/conditio
ns/diabetes/normal-regulation-bloodglucose
Type 1 vs. Type II Diabetes Mellitus (DM)
Type I
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Type II
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Gestational Diabetes
Placental hormones cause insulin resistance
All women screened 24-28 weeks gestation
Diet, exercise, blood sugar monitoring, insulin
More likely to develop Type II within 10 years
Cardinal Manifestations
The 3 P’s
How might these s/s present in clients
you see?
Why
Polyuria and
Polydipsia?
(Osmotic Diuresis)
Rationale:
Why Polyphagia?
Rationale:
Other Manifestations
How else might a client present with diabetes?
Diagnosis
oHow are pattern blood sugars/fasting blood sugars helpful? What makes
something a “fasting” blood sugar?
oGlycated Hemoglobin (A1C)—how is this used? What is “normal”? What is a
target range for a diabetic?
oWhere are ketones found? What does this indicate?
oWhat are other S/S the client may present with that indicate potential DM?
Diagnosis
Criteria
◦Symptoms + BS greater than 200mg/dL at any time
of day
OR…..
◦Fasting BS greater or equal to 126mg/dL OR…
◦BS 200mg/dL or greater 2 hours after oral glucose
tolerance test
OR….
◦A1C greater than 6.5%
Goals of Medical Management
Prevent complications
Stabilize insulin and BS levels
Treat aggressively to prevent
morbidity/mortality
Goals of Medical Management
NUTRITION
EXERCISE
MONITORING
PHARMACOLOGY
EDUCATION
Nutrition
What would you share with a client regarding nutrition? Are there any tools that could assist
them in meal planning?
Exercise
WHAT EDUCATION REGARDING EXERCISE WOULD BE IMPORTANT?
Monitoring
What should patients know about monitoring blood sugars?
INSULIN
Pharmacology
• Type I-- lifelong treatment
• Type II-- if diet/exercise/po meds
not effective
• Gestational--sometimes necessary
May need multiple types at
multiple times to control BS
Insulins
Rapid Acting
Onset
Duration
Peak
Prototype
Education
Short Acting
Intermediate
Acting
Very Long Acting
General Insulin Information
Refrigerate when not in use
Current source kept at room temp x 1 month
Always have spare
Use properly calibrated syringe (U50, U100)
Rotate injection within same site or use same
site at same TOD
Insulin Delivery Methods
Insulin Pen
◦ Disposable needle
◦ Dial up dosage
◦ Convenient, less intimidating, simplified
Insulin Pump
◦
◦
◦
◦
Mimics natural action of pancreas
Delivered continuously @ basal rate
Demand doses based on intake
Convenient, must be willing to check BS/refill/monitor
Numerous Classes
Oral
Antidiabetic
Agents
Actions:
◦ Stimulates secretion of insulin
◦ Makes insulin more effective
◦ Inhibit glucose production of liver
◦ Increase body sensitivity to insulin
◦ Delayed absorption of carbohydrates
Prototype: metformin (Glucophage)
Action:
Oral
Antidiabetic
Agents
Increases chance of lactic ________ and
_________ failure
Avoid _________ __________ within 48 hours
of taking med
Hypoglycemia a concern?
Complications
Hypoglycemia
What s/s might be present?
What are common reasons for this occurrence?
What is the treatment?
Complications
Diabetic Ketoacidosis (DKA)
What are the most common s/s?
What are the most common causes?
What is treatment?
Complications
Hypoglycemia Hyperosmolar Syndrome (HHS)
What are the most common s/s?
What are the most common causes?
Treatments?
DKA vs. HHS
Complications
Long term:
◦ Macrovascular Complications
◦ Examples:
◦ Why are these concerning?
oMicrovascular Complications
oExamples
oWhy are these concerning?
Not just a
“sugar”
issue!