Module 8 Assessment and Management of Patients With Diabetes

Assessment &
Management of Patients
with Diabetes
BY: ROSELLE JOY C. BALAQUIT, RN, MANc
DIABETES
Diabetes is a group of Prediabetes
metabolic diseases classified as impaired
characterized by glucose tolerance (IGT) or
increased levels of impaired fasting glucose
glucose in the blood (IFG)
(hyperglycemia)
resulting from defects refers to a condition in
in insulin secretion, which blood glucose
insulin action, or both concentrations fall between
normal levels and those
considered diagnostic for
diabetes (CDC,2014)
CLASSIFICATION
 Type 1 diabetes
 Type 2 diabetes
 Gestational diabetes
 Latent autoimmune diabetes of
adults (LADA)
 Diabetes associated with other
conditions or syndromes
TYPE 1 DIABETES
 5% of adults Factors contribute to

 characterized by the beta cell destruction:
destruction of the
genetic
pancreatic beta cells thus
decreases insulin immunologic
production, increased
environmental
glucose production by the
liver and fasting (e.g.,viral)
hyperglycemia
TYPE 1 DIABETES
 renal threshold for glucose =  Diabetic Ketoacidosis (DKA)
180 to 200 mg/dL if exceeds,
kidneys may NOT reabsorb
common in Type 1
all of the filtered glucose; the results from a deficiency of insulin
glucose then appears in the
highly acidic ketone bodies are
urine (glycosuria)
formed and metabolic acidosis
 accompanied by excessive occurs
loss of fluids and electrolytes
= osmotic diuresis 3 metabolic derangements:
1. hyperglycemia
2. ketosis
3. metabolic acidosis
TYPE 2 DIABETES
 95% of adults
 common to above 30yrs old and obese
 2 main problemsr/t insulin:
insulin resistance - decrease tissue
sensitivity to insulin
impaired insulin secretion
 may also lead to metabolic syndrome:
hypertension
hypercholesterolemia
abdominal obesity & other
abnormalities
GESTATIONAL DIABETES
occurs 18% of pregnant woman

is any degree of glucose intolerance
with its onset during pregnancy
hyperglycemia develops during
pregnancy because of the secretion of
placental hormones which causes
insulin resistance
LADA
a subtype of diabetes in
which the progression of
autoimmune beta cell
destruction in the
pancreas is slower than
Type 1 and Type 2
diabetes
not insulin-dependent
PREVENTION
Type 2 diabetes can be

preventive with
appropriate changes in
lifestyle
CLINICAL MANIFESTATIONS
Classic clinical Other symptoms include:

manifestations of fatigue & weakness
diabetes:
sudden vision changes
Polyuria
tingling or numbness in
Polydipsia hands or feet
Polyphagia dry skin
skin lesions or wounds
that are slow to heal
recurrent infections
Assessment & Dx Findings
 Fasting Plasma Glucose

(FPG)
 Random plasma glucose
and glucose level 2 hrs
after receiving glucose (2-
hour postload)
Medical Management
Goal of diabetic treatment:

normalize insulin activity
blood glucose levels to reduce the development of
complications such as:
retinopathy
nephropathy
neurophathy
Medical Management
Five components:
Therapeutic goal for
diabetes management 1. nutritional therapy
is to achive normal 2. exercise
blood glucose levels
3. monitoring
(euglycemia) without
hypoglycemia while 4. pharmacologic
maintaning a high therapy
quality of life 5. education
Medical Management
1. Nutritional Therapy
control total caloric intake to attain or maintain a
reasonable body weight, control of blood glucose levels
and normalization of lipids and BP to prevent heart
disease.
 Identify patient’s eating habits, food preferences, lifestyle,
usual eating times and ethnic & cultural background
 Caloric requirements
 Caloric distribution
carbohydrates, fats, protein, & fiber
Medical Management
 Food Classification systems  Other dietary concern

 exchange lists  alcohol consumption
 nutritional labels  sweereners
 healthy food choices  misleading food labels
 MyPlate Food Guide
Medical Management
2. Exercise
 lowers blood glucose and reduce
cardiovascular risk factors
 exercise recommendations
 exercise precautions
Medical Management
3. Monitoring Glucose Levels

Self-monitoring of blood
glucose (SMBG) - a method
of capillary blood glucose
testing through a prick of
patient’s finger & applies a
drop of blood to a test strip
Medical Management

Using a continuous Glucose
Monitoring System
Medical Management

testing for glycated
hemoglobin
also referred as
glycosylated hemoglobin,
HgbA1C or A1C
measure of glucose
control for the past 3
months
Medical Management
3. Monitoring Glucose Levels and

ketones
Testing for ketones
ketones are by-products of fat
breakdown & they accumulate in
blood and urine and this signals
deficiency of insulin and control of
Type 1 diabetes is deteriorating
use a urine dipstick (Ketostix or
chemstrip uK)
purple - means ketones are
present
4. Pharmacologic Therapy
 Insulin Therapy
 Insulin Therapy
Insulin regimens see table
51-4 pg 1470
complications:
systemic allergic
reactions
insulin lipodystrophy
resistance of injected
insulin
morning hyperglycemia
 Insulin Therapy
 Methods of Insulin
Delivery
Insulin pens
jet injections
insulin pumps
future insulin
delivery
transplantation of
pancreatic cells
 Oral Antidiabetic Agents see Table 51-6 page 1474-1475

Medical Management
5. Educating Patients
Medical Management
5. Educating Patients to Self-Administer

Insulin
storing insulin
selecting syringes
mixing insulins
withdrawing insulins
selecting &rotating the injection site
preparing the skin
inserting the needle
disposing of syringes and needles
Patient Education
DIABETES
 Criteria For determining Effectiveness of Self-Injection of Insulin

Education see Chart 51-8 page 1481
HYPOGLYCEMIA (INSULIN
REACTIONS)
low sugar in the blood

blood glucose falls to less than 70 mg/dL.
severe hypoglycemia - <40mg/Dl
Occurs when:
too much insulin or oral hypoglycemia agents
too little food
excessive physical activity
HYPOGLYCEMIA
 Clinical Manifestations:
 mild = sweating, tremor, tachycardia, palpitation, nervousness and
hunger
 moderate = (deprives brain cells) inability to concentrate,
headache, lightheadedness, confusion, memory lapses, numbness
of lips & tongue, slurred speech, iaired coordination, emotional
changes, irrational or combative behavior, double vision and
drowsiness
 severe = disoriented behavior, seizures, difficulty arousing from
sleep or loss of consciousness
HYPOGLYCEMIA
Management:
Treating with carbohydrates
Initiating emergency measures
DIABETIC KETOACIDOSIS
is caused by an absence or inadequate amount of

insulin, results in disorders in the metabolism of
carbohydrate, protein and fat
Three main clinical features of DKA:
hyperglycemia
dehydration & electrolyte loss
Acidosis
 Prevention
 Clinical Manifestations  ketosis & acidosis of DKA

polyuria lead to:
polydipsia gastrointestinal symptoms

such as anorexia, NV,
fatigue abdominal pain
blurred vision acetone breath
weakness hyperventilation/
headache kussmaul respirations
orthostatic hypotension may be alert, lethargic or
weak, rapid pulse comatose
 Assessment & Dx Findings

low serum bicarbonate (0-15mEq/L & low pH (6.8-7.3)
low partial pressure of carbon dioxide (PCO2 10-30 mmHg)
increased levels of creatinine, BUN & hematocrit
Management
correct dehydration, electrolyte loss and acidosis
before correcting the hyperglycemia with insulin
rehydration
restoring electrolytes
reversing acidosis
Hyperglycemic hyperosmolar syndrome (HHS)
is a metabolic disorder of type 2 diabetes

resulting from a relative insulin deɹ ciency
initiated by an illness that raises the
demand for insulin.
Clinical Manifestations Assessment & Dx

hypotension Findings
blood glucose level of
dehydration
600 to 1200 mg/dL
tachycardia osmolality exceeds
variable neurologic 320 mOsm/kg
signs (e.g., alteration BUN, CBC, ABG
of consciousness, analysis, electrolytes
seazures, hemiparesis
Management
fluid replacement - 0.9% or 0.45% NS
correction of electrolyte imbalances
insulin administration
LONG-TERM COMPLICATIONS OF DIABETES
Macrovascular
coronary artery disease
cerebrovascular disease
peripheral vascular disease
Microvascular
Diabetic retinopathy
Nephropathy
Neuropathies

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Assessment &

 5% of adults Factors contribute to

occurs 18% of pregnant woman

Type 2 diabetes can be

Classic clinical Other symptoms include:

 Fasting Plasma Glucose

Goal of diabetic treatment:

 Food Classification systems  Other dietary concern

3. Monitoring Glucose Levels

3. Monitoring Glucose Levels

3. Monitoring Glucose Levels

3. Monitoring Glucose Levels and

 Oral Antidiabetic Agents see Table 51-6 page 1474-1475

5. Educating Patients to Self-Administer

 Criteria For determining Effectiveness of Self-Injection of Insulin

low sugar in the blood

is caused by an absence or inadequate amount of

 Clinical Manifestations  ketosis & acidosis of DKA

polydipsia gastrointestinal symptoms

 Assessment & Dx Findings

is a metabolic disorder of type 2 diabetes

Clinical Manifestations Assessment & Dx

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