Unit 1 - Diabetes Flashcards
Evidence from 2016 indicated that:
Diabetic complications are r/t (1)
Diabetes contributes to (4)
Diabetes is the leading cause of (1)
premature death (lifespan reduced by 5-15 years)
30% of strokes
40% of heart attacks
50% of kidney failure requiring dialysis
70% on non-traumatic lower limb amputations
vision loss
Seniors and Diabetes
What %age of people with diabetes are age 65 and older?
What are important for decreasing risk for developing diabetes in elderly people?
Describe diabetes in the elderly in comparison to that of younger people.
Therefore?
Approximately 25.9 %
.
Lifestyle interventions
Diabetes in the elderly is metabolically distinct from that of younger people
It therefore should be treated differently.
(Canadian Diabetes Association, 2013).
Aboriginal People and Diabetes
Aboriginal populations living in Canada are among…
Diabetes prevention efforts should focus on?
Diabetes screening for adults should occur how often?
Are males or females more impacted by DMII?
When?
Aboriginal women in Canada experience gestational diabetes at a rate that is…
the highest risk populations for diabetes and related complications
diabetes risk factors (obesity, proper management of gestational diabetes, smoking, inactivity, poor eating habits, and stress)
every 1-2 years for individuals with one or more risk factors
Aboriginal females are impacted by type 2 diabetes more than males, with the most noticeable difference being seen during reproductive years.
2-3 times higher than other women.
Diabetes and Psychiatric Illness
Psychiatric disorders are more prevalent in…
People diagnosed with psychiatric illness are more likely to
Those individuals with both diabetes and psychiatric illness have decreased (2)
Those individuals with both diabetes and psychiatric illness have increased (4)
Risk factors leading to insulin resistance and metabolic disorder? (4)
people with diabetes than in the general population.
develop diabetes than the general population.
medical adherence
self-care
functional impairment
risk of diabetic complications
healthcare costs
mortality
Psychotropic drugs cause weight gain COMBINED WITH poor diet inadequate exercise smoking common in this population
The Economic Costs of Diabetes
The economic burden of diabetes in Manitoba is estimated to be ? in 2010
How much was the cost expected in increase by 2020?
Estimated cots in 2020 (by Canadian Diabetes Association)?
$498 million in 2010 (measured in 2009 dollars)
28%
$639 million
Definitions
Diabetes
a metabolic disorder characterized by the inability to manufacture or properly use insulin
and
impaired ability to convert sugars, starches, and other foods into energy.
Definitions
Diabetes in terms of blood glucose (2)
FBG - fasting blood glucose > 7.0 mmol/L
or
2 hour blood sugar of > 11.1 mmol/L
Definitions
Type 1 Diabetes
More commonly Dx’ed in?
Etiology
children and adolescents
Pancreatic beta cell destruction causes the pancreas to stop producing insulin.
Without enough insulin, glucose isn’t metabolized properly, so it builds up in the bloodstream.
Type 1 Diabetes
What is thought to be the cause of beta cell destruction?
Onset?
Prevention?
an autoimmune process
can be sudden
Cannot be prevented.
Type 1 Diabetes
How is it treated?
diet
exercise
insulin (clients are dependent)
What % of people Dx’ed with diabetes have type 1?
10% of people diagnosed with diabetes have Type 1 diabetes.
Type 2 Diabetes
Commonly diagnosed in?
Etiology?
Onset?
adults
The pancreas does not produce enough insulin
or
the body does not use the insulin effectively (insulin resistance).
Can be slow in onset.
Type 2 Diabetes
How is it treated?
diet
exercise
oral medication and/or insulin
What % of people Dx’ed with diabetes have type 2?
90% of people diagnosed with diabetes have Type 2 diabetes.
Prediabetes is defined as?
Prediabetes is associated with?
blood sugars that are above normal levels
but
below those of diabetes
an increased risk of developing either diabetes or cardiovascular disease.
IFG
impaired fasting glucose
IFG - impaired fasting glucose is
6.1 to 6.9 mmol/L
IGT
impaired glucose tolerance
IGT - impaired glucose tolerance is
2 hour blood sugar of 7.8 to 11.1 mmol/L
What is a key feature of type 2 diabetes?
Insulin resistance
Define Insulin Resistance
a condition in which the body’s cells and tissues do not respond properly to the effects of insulin.
Insulin resistance is a key feature of type 2 diabetes.
It is also implicated in? (2)
prediabetes and metabolic syndrome
Metabolic Syndrome is…
It is defined as people with 3 or more of the following 5 risk factors:
a grouping of conditions that is associated with a higher risk of developing diabetes and/or cardiovascular disease
Metabolic Syndrome is…
5 risk factors:
Fasting Blood Sugar > 6.1 mmol/L
Blood Pressure > 130/85
Triglycerides > 1.7 mmol/L
HDL- cholesterol
Men < 1.0 mmol/L
Women < 1.3 mmol/L
Waist Circumference
Men > 102 cm
Women > 88 cm
How many of the five risk factors must the person have to be Dx’ed with metabolic syndrome?
3 or more
Targets for control of blood sugar
NORMAL RANGE
Hgb A1C %
Fasting glucose
2 hour glucose
Hgb A1C %: < 6.0
Fasting glucose: 4.0 – 6.0 mmol/L
2 hour glucose: 5.0 – 8.0 mmol/L
Targets for control of blood sugar
TARGETS FOR MOST DIABETICS
Hgb A1C %
Fasting glucose
2 hour glucose
Hgb A1C %: < 7.0
Fasting glucose: 4.0 – 7.0 mmol/L
2 hour glucose: 5.0 – 10.0 mmol/L
Risk Factors for Type 2 Diabetes
Genetics (2)
Parent of sibling with diabetes
Belonging to high-risk group
Aboriginal, African, Asian, South Asian, Hispanic descent
High risk groups
Aboriginal African Asian South Asian Hispanic
Risk Factors for Type 2 Diabetes
Women’s Woes (3)
Having baby that weighed more than
4kg (9 pounds) at birth
Gestational diabetes (diabetes during pregnancy)
polycystic ovary syndrome Dx
Risk Factors for Type 2 Diabetes
Pre-exisiting diagnoses (4)
Prediabetes (impaired glucose tolerance or impaired fasting glucose)
obstructive sleep apnea
Acanthosis nigricans (darkened patches of skin)
psychiatric disorders: schizophrenia, depression, bipolar
Risk Factors for Type 2 Diabetes
High? (3)
High BP
High cholesterol or other fats in the blood
High weight (overweight), especially if mostly carried around the tummy
Risk Factors for Type 2 Diabetes
Other (2)
Having health complications that are associated with diabetes
Having been prescribed a glucocorticoid med
Prevention of Type 2 Diabetes
EARLY SCREENING recommended
For those without risk factors?
For those with risk factors?
Q 3 years starting at age 40
For those with risk factors, testing should be done more frequently and from an earlier age.
Promotion of life style changes that include weight management through diet and regular physical activity for those with prediabetes and/or metabolic syndrome.
Prevention of Type 2 Diabetes
In Manitoba, screening of obese children recommendations.
> 7 years of age
Q 2 years IF members of a high risk ethnic group or have a family hx
Treatment of Type 2 Diabetes
Treatment is aimed at?
Using?
To?
control of blood sugar
using diet, exercise, oral medications and/or injected insulin
to control symptoms
and
reduce or prevent complications
Each 1% drop in Hgb A1C is associated with:
- 43% less risk of amputation
- 37% less risk of microvascular complications
- 21% less risk of diabetes complications
- 21% less risk of death related to diabetes
- 19% less risk of cataract extraction
- 16% less risk of heart failure
- 14% less risk of heart attack
- 12% less risk of stroke
- Reduced number of hospital stay days.
What is the ONLY treatment to prevent the onset and delay the progression of diabetic neuropathy?
Control of blood sugar to within the recommended target range
is the ONLY treatment
Diet and Diabetes
CDA 2013 Clinical Practice Guidelines recommend …
nutrition counselling from a registered dietician for all diabetics.
Refer to and other publications from the CDA website.
Diet and Diabetes
Recommended CDA publication?
“Just the Basics - Tips for healthy eating, diabetes prevention and management”
Physical Activity and Diabetes
Exercise and physical activity has been shown to be a very important part of…
controlling blood sugar and reducing complications in diabetes.
Physical Activity and Diabetes
Recommended CDA publication?
“Physical Activity and diabetes management”
Diabetes, Depression and Anxiety
Symptoms of depression are often seen in clients with diabetes and research is demonstrating that…?
approximately 15% of diabetics
have symptoms of major depression
Diabetes, Depression and Anxiety
Many of the physical symptoms of depression and diabetes are?
the same
The CDA 2013 Clinical Practice Guidelines are now recommending that regular screening for depression and anxiety be done with referral to mental health professionals for those with depression, anxiety or eating disorders.
There is literature available for the public and professionals on the CDA website.
Diabetes, Depression and Anxiety
Many of the physical symptoms of depression and diabetes are the same, therefore…?
This may be leading to…?
many health professionals assume that depression is inevitable with chronic illness
this may be leading to under-diagnosis
Diabetes, Depression and Anxiety
There is evidence of ??? among diabetics than in the general population.
There is evidence of more generalized anxiety disorder among diabetics than in the general population.
Diabetes, Depression and Anxiety
What % of diabetics have some anxiety Sx?
Often experienced is…?
14%
fear of hypoglycemia
The Diabetes Management Team
The person with diabetes needs to?
In order to?
This can seem like?
balance diet, exercise and medication
control their disease and manage complications
a difficult and daunting undertaking for many
The Diabetes Management Team
This is most successfully done with the help of a multidisciplinary team that may include…
DD E FF P
dietician diabetes educator nurse endocrinologist foot care specialists family doctor pharmacist
The Diabetes Management Team
What is essential for the long-term management and support that diabetics need?
Good communication
and
common current standards of care among caregivers
The Diabetes Management Team
CDA Clinical Practice Guidelines also make recommendations for?
the integration of mental health professionals
and the use of CBT based techniques
onto the diabetes team
The Foot Care Nurse as a Member of the Diabetes Health Care Team
(5)
Know the current basics of diabetic management
Know where clients can get diabetes education locally
Be prepared to make and receive referrals within your local team
Support ALL positive efforts that clients make to improve self care
Document and follow up all referrals.
The Foot Care Nurse as a Member of the Diabetes Health Care Team
Know the current basics of diabetic management:
targets for glucose testing and Hgb A1C
managing hypoglycemia
managing ‘sick days’
current care recommendations for foot care
(CDA Diabetes Service Directory 2018 Clinical Practice Guidelines)
The Foot Care Nurse as a Member of the Diabetes Health Care Team
Know where clients can get diabetes education locally
health resource centres, hospital or clinics
- Manitoba Health – Chronic Diseases Branch – Diabetes
home care resource
pharmacy
web based resources
- Canadian Diabetes Association
- WRHA Diabetes Service Directory
health links
The Foot Care Nurse as a Member of the Diabetes Health Care Team
Be prepared to make and receive referrals within your local team
keep referral information readily available
know what information is needed to make a referral
keep business cards with your information handy
be prepared to explain what you do to others
The Foot Care Nurse as a Member of the Diabetes Health Care Team
Support ALL positive efforts that clients make to improve self care
encourage them to seek answers to their questions
encourage them to persist in their efforts
be prepared give support repeatedly
The Foot Care Nurse as a Member of the Diabetes Health Care Team
Document and follow up all referrals.
That’s it.
S/S hyperglycaemia
Excess glucose in the blood creates an osmotic effect that results in increased thirst, hunger, and increased urination.
The patient may also report nonspecific symptoms of fatigue, mild confusion, lethargy
blurred vision
HA
warm, dry skin
Hyperglycaemia Tx
Insulin
Exercise Regularly. ... Control Your Carb Intake. ... Increase Your Fiber Intake. ... Drink Water and Stay Hydrated. ... Implement Portion Control. ... Choose Foods With a Low Glycemic Index. ... Control Stress Levels. ... Monitor Your Blood Sugar Levels. 9. Get Enough Quality Sleep Eat Foods Rich in Chromium and Magnesium
S/S hypoglycaemia
Capillary blood glucose level, weakness, fatigue, muscle cramps, decreased muscle tone, insomnia, tachycardia, tachypnea, dizziness, headaches, numbness/ tingling, decreased level of consciousness, or change in consciousness, seizure, visual impairment
anxiety, irritability, dizziness, diaphoresis, pallor, tachycardia, headache, shakiness, and hunger.
severe hypoglycemia may lead to alteration of mental function that proceeds to headache, malaise, impaired concentration, confusion, disorientation, irritability, lethargy, slurred speech, and irrational or uncontrolled behavior
Hyperglycaemia Tx
Eat or drink 15 to 20 grams of fast-acting carbohydrates. These are sugary foods without protein or fat that are easily converted to sugar in the body. Try glucose tablets or gel, fruit juice, regular — not diet — soft drinks, honey, and sugary candy.
Recheck blood sugar levels 15 minutes after treatment. If blood sugar levels are still under 70 mg/dL (3.9 mmol/L), eat or drink another 15 to 20 grams of fast-acting carbohydrate, and recheck the blood sugar level again in 15 minutes. Repeat these steps until the blood sugar is above 70 mg/dL (3.9 mmol/L).
Have a snack or meal. Once your blood sugar is normal, eating a snack or meal can help stabilize it and replenish your body’s glycogen stores.
