CMT Training
The Center for Life Enrichment
Resource: MTTP Student Manual
 Diabetes
is a disorder in which the body
does not properly utilize or release
insulin which results in abnormally high
levels of serum (blood) glucose
 In
the normal process of digestion,
consumed sugars and starches
(carbohydrates) and other foods are
changed into a form of sugar called glucose
 Glucose is distributed throughout the body
and is used as the energy source for the
body’s cells
 The rise in blood sugar associated with
eating triggers the pancreas to secrete the
hormone called insulin
 Insulin
is required to allow the blood
glucose to leave the bloodstream and
either enter the body’s cells where it is
used for energy or enter the liver where
it is stored for future use
 In diabetes, either the body does not
properly use the insulin that is secreted
by the pancreas or the pancreas secretes
too little or no insulin
If the body does not properly use the insulin that is
secreted by the pancreas or the pancreas secretes
too little or no insulin, the glucose collects in the
blood
 These high levels of blood glucose, over time, cause
complications such as:

Damage to the retinas of the eyes (Diabetic Retinopathy)
Nerve damage (Neuropathy)
Kidney failure
Blood vessel damage (increasing the incidence of heart attack
& stroke)
• Reduced circulation (increasing the risk of infection and the
potential for amputation)
• Impotence
• Complications of pregnancy
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TYPE I DIABETES
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The pancreas secretes too
little or no insulin
The person must receive
insulin injections to allow
the blood glucose to be
utilized and/or stored
properly
TYPE II DIABETES
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The insulin that is produced
by the pancreas cannot be
utilized effectively
Diet & exercise are
employed as the first line of
treatment
If diet & exercise are not
sufficient, oral agents or
insulin may be required
 The
exact cause of diabetes is not known
TYPE I DIABETES
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Scientists believe that a
genetic predisposition
coupled with
environmental factors
cause the immune system
to attack the pancreas and
destroy the cells that
produce insulin
Most people who have
Type I Diabetes develop
the disease before the age
of 30
TYPE II DIABETES
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Though the pancreas continues
to produce insulin, the insulin is
ineffective
Identified risk factors for Type
II Diabetes:
• Obesity (excessive fat prevents
insulin from working properly)
• Specific racial/cultural groups
(African Americans and
Hispanics have a higher
incidence)
• Family History

Diet, exercise, and oral
medications are used for
treatment
 Oftentimes, signs
and symptoms of Type I
Diabetes occur suddenly and include:
• Frequent urination (polyuria)
• Increased thirst (polydipsia)
• Rapid weight loss (often in the presence of
increased appetite – polyphagia)
• Irritability
• Nausea & vomiting
 The
signs & symptoms of Type II Diabetes
are usually more gradual in onset
 In addition to the signs & symptoms
mentioned on the previous slide, the signs &
symptoms of Type II Diabetes may include:
• Hard to heal infections (especially of the skin, gums,
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or bladder)
Vision changes
Tingling or numbness of the distal extremities
Itching
Tiredness
 Regular
medical check-ups which
include laboratory monitoring are critical
in detecting abnormally high blood
glucose levels
 Physical exams are encouraged annually
by TCLE
 The
goal of medication therapy for both
Type I and Type II Diabetes is to maintain
the blood sugar levels within normal
range
 Acceptable normal standards are from 70
to 110 mg/dl

In Type I Diabetes, the treatment is to provide
insulin directly to the body
• Insulin is injected under the skin into the fat layer of the
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body
The fatty tissue of the upper arm, thigh, and abdomen are
the usual sites for administration
CMTs required to administer insulin receive special
training from the RN CM/DN before they are authorized to
administer insulin
Small syringes with very thin needles, insulin pens, or
insulin pumps may be used
CMTs are not allowed to calculate the insulin dose. CMTs
may be delegated the task of measuring insulin/filling
the insulin syringe at the discretion of the RN CM/DN
When an individual is diagnosed with Type II
Diabetes, dietary restrictions and an increase in
exercise will be tried to lower blood sugar levels
adequately
 If diet and exercise are not effective, oral
hypoglycemic agents will be utilized to lower blood
sugar levels adequately
 Oral hypoglycemic agents work by stimulating the
pancreas to increase the production of insulin, by
increasing the effectiveness of the insulin produced,
or by increasing the body’s ability to utilize its own
insulin
 If the body does not respond to oral agents, insulin
injections may be required

 Unwanted/side
effects of the medications
used to treat diabetes and complications
of the disease requiring emergency
intervention include:
• Hypoglycemia
• Hyperglycemia
• DKA (Diabetic Coma)
 Hypoglycemia
(low blood sugar) occurs
more commonly in individuals taking
insulin
 Often referred to as insulin shock or
insulin reaction
 Hypoglycemic reactions can occur
suddenly
 Feeling
shaky
 Becoming sweaty
 Feeling tired, weak, or nervous
 Feeling hungry
 Becoming irritable or confused
 Developing a headache
 Developing a rapid heart rate

It is critical that low blood sugar be treated immediately to
avoid unconsciousness and brain damage
• If the person is conscious, administer a quick acting sugar
by mouth to keep the person from losing consciousness:
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1/2 cup of sweetened fruit juice (OJ or Apple)
Hard candy
1/2 cup of regular soda
GlucoTabs
• If the person is unconscious, injecting Glucagon will
stimulate the release of the stored form of glucose,
glucogen, from the liver
 911 should be called and the person should be transported to
the nearest emergency room for evaluation and stabilization
 CMTs receive individualized training from the delegating
nurse before being authorized to administer glucagon
 Hyperglycemia
(high blood sugar)
occurs when the individual’s blood sugar
rises well above the normal range and
stays there—240 mg/dl or higher
 Hyperglycemia results from dietary
indiscretions, too little medication,
illnesses, and/or stress
 Hyperglycemia often has a slower
pattern of onset
 Thirstier
than usual
 Hungrier than usual
 More frequent urination
 Getting up at night to urinate
 Dry, itchy skin
 More tired than usual
 Changes in vision
 Infection
 Cuts or sores that heal slower than
normal
 The
best treatment is prevention
 Eat according to the prescribed meal
plan
 Take medications as prescribed
 Monitor blood sugar levels
 Maintain a routine pattern of exercise
 If hyperglycemia persists, call the
delegating nurse/Health Care
Professional
 DKA
(diabetic coma) is a dangerous
condition that is usually only seen in
Type I diabetics
 DKA occurs when an imbalance between
insulin and blood sugar is so out of
control that ketones are produced and
accumulate in the blood
 At high levels, ketones are poisonous to
the body
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Dry mouth
Excessive thirst
Loss of appetite
Excessive urination
Dry/flushed skin
Labored breathing
Fruity smelling breath (acetone odor)
Vomiting
Abdominal pain
Unconsciousness
If an individual is suspected of having DKA, the
delegating nurse should be contacted and 911
called
 It
is important for the individual/care giver
to:
• Inform the delegating nurse of any changes in health
• Know that the individual should wear a medic alert
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bracelet
Observe for signs and symptoms of hypoglycemia
and hyperglycemia, and intervene appropriately
Follow the prescribed diet
Maintain a regular pattern of exercise
Know that the individual should avoid the use of
alcohol
See a podiatrist regularly for foot care
Follow the Nursing Care Plan for foot care
 If
you have any questions or concerns
related to Diabetes and our participants,
contact TCLE’s delegating nurse
• 301-373-8100 *821