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Individuals Experiencing Diabetes Mellitus


Individuals Experiencing Diabetes Mellitus NURS2016 Diabetes Strategy The strategy includes an online registry that will enable better self-care by giving patients ... – PowerPoint PPT presentation

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Title: Individuals Experiencing Diabetes Mellitus

Individuals Experiencing Diabetes Mellitus
  • NURS2016

Diabetes Mellitus
  • A multisystem disease related to
  • Abnormal insulin production
  • Impaired insulin utilization
  • Both

Diabetes Mellitus
  • Leading cause of heart disease, stroke, adult
    blindness, and non-traumatic limb amputation
  • In Canada, 7th leading cause of death
  • Hospitalization rates are 2.4 and 5.3 X greater
    for adult and child than general population
  • Diabetes higher in Algoma and Cochrane
  • The number of Ontarians with diabetes has
    increased by 69 per cent over the last 10 years
    and is projected to grow from 900,000 to 1.2
    million by 2010

Local Reality (2007)
  • NELHIN 7.5
  • Nipissing Parry Sound 6.7
  • Timiskaming 10
  • Ontario as a whole 6.1

Type 1
  • Formerly known as juvenile diabetes
  • Most often occurs under 30 years of age
  • Peak onset 11-13 years

Type 1Onset of Disease
  • Manifestations develop when the pancreas can no
    longer produce insulin
  • Rapid onset of symptoms
  • Present in ER with ketoacidosis

Type 1
  • Weight loss
  • Polydipsia
  • Polyuria
  • Polyphagia

Type 1
  • Diabetic Ketoacidosis
  • Occurs in the absence of exogenous insulin
  • Life threatening
  • Results in metabolic acidosis

Type 2
  • Formerly called adult onset diabetes
  • Accounts of 90 of patients with diabetes
  • Usually gt40 years of age
  • Recently seen in children as young as 10
  • 80-90 are overweight

Type 2
  • Onset of disease is gradual
  • May be undetected for years

Recommended blood glucose targets for people with
  • HB AIC
  • Fasting blood glucose/ blood glucose before
    meals (mmol/L) Blood glucose two hours after
    eating (mmol/L)
  • Target for most patients with diabetes 7.0 4.0
    to 7.0 5.0 to 10 Normal range 6.0 4.0 to 6.0
    5.0 to 8.0
  • This information is based on the Canadian
    Diabetes Association 2008 Clinical Practice
    Guidelines for the Prevention and Management of
    Diabetes in Canada and is a guide. Talk to your
    doctor about YOUR blood glucose target ranges.
    A1C is a blood test that indicates an average of
    your overall blood glucose levels over the past
    120 days. A1C targets for pregnant women and
    children 12 years of age and under are different.

Diabetes MellitusCollaborative Care
  • Goals of diabetes management
  • Reduce symptoms
  • Promote well-being and quality of life
  • Prevent acute complications
  • Delay onset and progression of long-term

Clinical Manifestations
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Diabetic Ketoacidosis
  • A medical emergency
  • Sometimes brought on by stress, surgery,
    pregnancy, puberty, infection
  • 1 cause person with diabetes not taking his/her
    insulin (fed up or non-compliance)
  • S S
  • ketosis
  • dehydration
  • electrolyte and acid-base imbalance

  • Abd pain
  • Nausea
  • Vomiting
  • Hyperventilation
  • Fruity odor to breath
  • If untreated,
  • Altered LOC
  • Coma
  • death

Diabetic Coma
  • Bicarbonate buffering system fails to compensate
    for ketosis
  • Respirations increase in rate and depth
    (Kussmauls respirations) breath has fruity or
    acetone odour
  • Renal system attempts to excrete ketones which
    leads to hemoconcentration
  • Hemoconcentration impedes blood circulation
    leads to tissue anoxia lactic acid production
  • The rise in lactic acid production further
    acidifies blood pH
  • Rising ketones eventually overwhelms the bodys
    defenses against the acid the body succumbs to

  • To treat low blood sugar the 15/15 rule is
    usually applied. Eat 15 grams of carbohydrate and
    wait 15 minutes. The following foods will provide
    about 15 grams of carbohydrate
  • 3 glucose tablets
  • Half cup (4 ounces) of fruit juice or regular
  • 6 or 7 hard candies
  • 1 tablespoon of sugar
  • After the carbohydrate is eaten, the person
    should wait about 15 minutes for the sugar to get
    into their blood. If the person does not feel
    better within 15 minutes more carbohydrate can be
    consumed. Their blood sugar should be checked to
    make sure it has come within a safe range.

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Diabetes MellitusCollaborative Care
  • Patient teaching
  • Nutritional therapy
  • Drug therapy
  • Exercise
  • Self-monitoring of blood glucose

Complications Acute
  • Acute
  • Hypoglycemia sweating, tremor, tachycardia,
    palpitations, nervousness, hunger, -- confusion,
    numbness lips/tongue, slurred speech, --
    irrational/combative behaviour disoriented,
    seizures, loss of consciousness
  • Immediate Treatment 15gm of fast-acting carb

Complications Acute
  • Diabetic Ketoacidosis
  • Hyperglycemia dehydration and electrolyte loss,
  • Polyuria, polydipsia, blurred vision,
    dehydration, weakness, headache
  • Tx rehydration, electrolyte balance, reversing
  • Monitoring fld/electrolyte status, glucose
    levels, administering insulin drip blood
    glucose is usually corrected before acidosis

Complications Long-Term
  • Angiopathy
  • Retinopathy
  • Nephropathy
  • Neuropathy
  • Skin problems
  • Infection

Nutritional Therapy
  • Overall goal assist people in making changes in
    nutrition and exercise habits that will lead to
    improved metabolic control
  • Canadas Food Guide Exchange System

Nutritional therapy
  • Type 1
  • Meal plan based on the individuals usual food
    intake and is balanced with insulin and exercise
  • Type 2
  • Emphasis placed on achieving glucose, lipid, and
    blood pressure goals
  • Caloric reduction

Nutritional therapy
  • Food composition
  • Individual meal plan developed with a dietician
  • Nutritionally balanced
  • Does not prohibit the consumption of any one type
    of food
  • Dietician provides initial support

  • Essential part of diabetes management
  • Increases insulin sensitivity
  • Lowers blood glucose levels
  • Decreases insulin resistance
  • Several small complex carbohydrate snacks can be
    taken q30m during exercise

  • Best done after meals
  • Monitor blood glucose levels before, during and
    after exercise

Blood Glucose Monitoring
  • Enables patient to make self-management decisions
  • Important for detecting episodic hypo or
    hyperglycemic events

Nursing Management
  • Assessment
  • Weight loss/gain
  • Thirst
  • Hunger
  • Healing pattern

Nursing Management
  • Nursing diagnosis
  • Ineffective therapeutic regime management
  • Fatigue
  • Risk for infection
  • Powerlessness

Nursing Management
  • Goals
  • Active patient participation
  • No episodes of acute hypo or hyperglycemia
  • Maintaining normal blood glucose levels
  • Prevent complications
  • Lifestyle adjustment with minimal stress

Ontario Launches Diabetes Strategy
  • 741 Million Plan Will Make Patients Partners In
    Care July 22, 2008
  • Ontario is investing 741 million in new funding
    on a comprehensive diabetes strategy over four
    years to prevent, manage and treat diabetes. 

Diabetes Strategy
  • The strategy includes an online registry that
    will enable better self-care by giving patients
    access to information and educational tools that
    empower them to manage their disease. The
    registry will also give health care providers the
    ability to easily check patient records, access
    diagnostic information and send patient alerts.  

Key elements of the strategy include
  • Increasing access to team-based care closer to
    home by mapping the prevalence of diabetes across
    the province and the location of current diabetes
    programs in order to align services and address
    service gaps.
  • Ontarios diabetes strategy will help tackle a
    growing and expensive health care challenge..
    Treatment for diabetes and related conditions
    such as heart disease, stroke, and kidney disease
    currently cost Ontario over 5 billion each year.
  • Improving access to insulin pumps and supplies
    for more than 1300 adults with type 1 diabetes by
    funding these services for people over the age of
  • Expanding chronic kidney disease services,
    including greater access to dialysis services.
  • Implementing a strategy to expand access to
    bariatric surgery. 
  • Educational campaigns to prevent diabetes by
    raising awareness of diabetes risk factors in
    high risk populations, such as the Aboriginal and
    South Asian communities.
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