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Caring for people with diabetes

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Module 3.2.2
Caring for people with
diabetes
Understanding diabetes,
supporting the individual and
planning care
Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health Diabetes Prevention and Management Initiative
June 2005
Presentation purpose
Target audience
Grade 2 nurses, aged care workers and personal care assistants
Aim
пЃ¬
пЃ¬
To provide best practice care for people with diabetes.
Objectives
Provide an overview of diabetes and how it affects the body.
Discuss what information people with diabetes require in order to
understand their condition and appropriate education strategies to
provide this information.
пЃ¬ Discuss best practice care for people with diabetes.
пЃ¬ Discuss role of carers in promoting best practice care.
пЃ¬ Discuss guidelines in relation to care planning for diabetes.
пЃ¬
пЃ¬
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Overview of diabetes
Diabetes means that blood glucose in
the body (often called blood sugar) is
too high
пЃ¬ Glucose comes from the food we eat
пЃ¬ Glucose is transported by the blood
stream to all the cells in the body.
Muscle
пЃ¬
G
G
G
G
G
G
G
G
Bloodstream
G
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Overview of diabetes
пЃ¬
Insulin helps the glucose from
food get into your cells.
Muscle
G
G
G
G
insulin
пЃ¬
Insulin is a chemical (a
hormone) made in a part of the
body called the pancreas.
PANCREAS
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Overview of diabetes
If your body doesn't make
enough insulin or if the
insulin doesn't work the way
it should, glucose can't get
into cells.
пЃ¬ Glucose stays in the blood.
пЃ¬ Blood glucose levels get too
пЃ¬
high, causing
Muscle
diabetes.
Bloodstream
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Common types of diabetes
Type 1
Type 2
Age of onset
Usually <40 years
Body weight
Lean
Usually >40
years
Usually obese
Prone to
ketoacidosis
Medication
Yes
No
Insulin essential
Onset of
symptoms
Acute
Tablets and /or
insulin
Gradual (may be
asymptomatic)
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Complications of diabetes
пЃ¬
Diabetes can cause increased risk of:
Heart Problems
п‚Ў Stroke
п‚Ў Eye sight problems
п‚Ў Kidney problems
п‚Ў Foot problems
п‚Ў
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment goals
Symptom free
пЃ¬ Prevent short term complications
пЃ¬ Prevent long term complications
пЃ¬ Quality of life =
Lifestyle focus
пЃ¬
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Cornerstones of treatment
Physical activity
Diet
Insulin/tablets
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Healthy eating
To help control blood glucose,
blood fats and adequate body
weight
пЃ¬ Healthy Eating
п‚Ў Regular carbohydrate
п‚Ў High in fibre
п‚Ў Low in fat (particularly saturated
пЃ¬
fat)
п‚Ў
п‚Ў
Low in added sugar
Adequate energy
/protein/fluids/vits and mins
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Exercise / activity
пЃ¬
30 minutes moderate intensity most days
preferably all
пЃ¬
Helps to:
Increased insulin sensitivity
п‚Ў Decreased insulin requirements
п‚Ў Weight reduction
п‚Ў Lipid control
п‚Ў Blood pressure control
п‚Ў
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Insulin and tablets
пЃ¬
Type 2 diabetes treatment may be
п‚Ў
п‚Ў
п‚Ў
п‚Ў
пЃ¬
Healthy eating
Healthy eating + tablets (several different types of
tablets may be on combination of tablets
Healthy eating + tablets + insulin
Healthy eating and insulin
Type 1 diabetes always require insulin
п‚Ў
п‚Ў
п‚Ў
May have long acting 1-2 times a day
Short and long acting 1-4 times a day
Continuous – insulin pump
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Hypoglycaemia
Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health Diabetes Prevention and Management Initiative
June 2005
What you need to know!
Blood glucose level that is considered low
пЃ¬ Signs and symptoms
пЃ¬ Causes
пЃ¬ Plan of action to treat
пЃ¬ Strategies to prevent hypoglycaemia
пЃ¬
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Definition of hypoglycaemia
пЃ¬
Blood glucose level below 3.5 mmol/L
in people with diabetes who are
treated with insulin or oral
hypoglycaemic agents
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Symptoms
feeling dizzy/shaking
profuse sweating
headache
pins and needles
around mouth
excessive hunger
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Cognitive impairment
пЃ¬
Symptoms of cognitive impairment
Peculiar behaviour
Lack of concentration
Altered vision
Loss of consciousness
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Nocturnal hypoglycemia
пЃ¬
Symptoms may include:
Sweating
п‚Ў Vivid dreaming
п‚Ў Restlessness
п‚Ў Incontinence
п‚Ў Waking with a headache
п‚Ў High or low fasting levels
п‚Ў
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Act quickly
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment
пЃ¬Treat
hypoglycaemia with quickly absorbed
glucose (15 gm carbohydrate in total) eg.
п‚Ў 100
ml Lucozade
п‚Ў 150 ml lemonade
п‚Ў 5 Jelly beans
п‚Ў 4 Jelly babies
п‚Ў 3 heaped teaspoons of sugar
п‚Ў 3 glucose tablets
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment
If symptoms have not resolved in 5-10
minutes treatment needs to be
repeated.
пЃ¬ Followed up initial treatment with
carbohydrate which is more slowly
absorbed
eg. Sandwich or fruit
пЃ¬
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Never
Never give food to an unconscious
person
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment if unconscious
Position in the left lateral position and
withhold any food or fluids. Seek
further medical help.
пЃ¬ If glucagon is available it can be
administered subcutaneously,
intramuscularly or intravenously.
пЃ¬
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Causes of Hypoglycemia
Insufficient food or delayed
meal or snack
Excess of
insulin and
some oral
hypogycemic
agents
insulin
Extra physical activity
or exercise
Alcohol consumed without food or
excess alcohol
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Hyperglycaemia
Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health Diabetes Prevention and Management Initiative
June 2005
What you need to know!
What is hyperglycaemia
пЃ¬ Causes
пЃ¬ Describe the main principles of the
treatment
пЃ¬ Diabetic Ketoacidosis
пЃ¬ Hyperosmolar non ketotic coma
пЃ¬
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Hyperglycaemia
Persistent BGL over 10 mmol/L
пЃ¬ Signs and symptoms of hyperglycaemia
пЃ¬
Polyuria
п‚Ў Polydipsia
п‚Ў Blurred vision
п‚Ў Weight loss
п‚Ў Infections, thrush
п‚Ў Tired
п‚Ў
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Causes of Hyperglycaemia
Increased weight
пЃ¬ Incorrect foods or amount of foods
пЃ¬ Forgetting or insufficient medication lack
of physical activity
пЃ¬ Stress
пЃ¬ Certain medications
пЃ¬ Illness /infections
пЃ¬
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Treatment
Relieve symptoms
пЃ¬ Increase monitoring
пЃ¬ Identify cause treat accordingly
пЃ¬ Observe for signs of concurrent illness or
infection
пЃ¬
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Managing Type 2 if illness present
пЃ¬
BGLs
п‚Ў
пЃ¬
Drink 1 glass of fluid per hour
п‚Ў
п‚Ў
пЃ¬
Monitor 2-4 hourly, record BGLs
If on diet or metformin water or diet lemonade
If on sulfonylureas/insulin - diet or regular
lemonade depending on BGL
Contact Dr
п‚Ў
п‚Ў
If becoming drowsy, vomiting or dehydrated
If BGLs over 15mmol for 24 hours
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
Managing Type 1 if illness present
пЃ¬
Fluids
п‚Ў
пЃ¬
Insulin
п‚Ў
пЃ¬
Test 2-4 hrly, may require extra short acting insulin
Ketones
п‚Ў
пЃ¬
Never omit even if not eating
BGLs
п‚Ў
пЃ¬
Drink 1 glass of fluid per hour. Sweetened if BGL below 15mmol
- unsweetened if above 15mmmol
Test for ketones if ill, BGL > 15 for 24 hours, or if vomiting
Contact Dr
п‚Ў
п‚Ў
If becoming drowsy or dehydrated
If vomiting or ketones present
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
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