TEACHING PLAN 1 DIABETES MELLITUS 1. The term “diabetes mellitus” refers to group of diseases that affect how body uses blood glucose, commonly called blood sugar. Glucose is vital to the health because it’s an important source of energy for the cells that make up muscles and tissues. It’s brain’s main source of fuel. When a person eats, the sugar — or glucose — from digested food enters the bloodstream. Glucose then moves from the blood into the body’s cells with the help of insulin.
Insulin helps “open the door” to cells in the body to allow glucose to enter. As type 2 diabetes develops, the body’s cells resist insulin, and beta cells — cells in the pancreas that release insulin — need to release much more insulin than they normally would. In people with type 2 diabetes, the beta cells gradually stop releasing enough insulin to help bring sugar into cells, causing higher levels of blood sugar. These beta cells gradually stop working the way they should.
As the number of beta cells goes down, the pancreas releases less and less insulin. As a result, glucose does not make its way into the cells and ends up staying in the blood, causing high blood sugar, or hyperglycemia. 2. It is important to maintain normal blood sugar level. Keeping blood sugar under control can help in the prevention of crashes, which contribute to feelings of dizziness, nausea and lightheadedness. For best results, be sure to choose foods which are low in simple sugars, eat frequent meals.
The average blood sugar rises gradually and as it rises there is damage occurring throughout the body. Out of control blood sugar levels can lead to serious short term problems such as hypoglycemia, hyperglycemia, or diabetic ketoacidosis (an acute, major, life-threatening complication of diabetes, a state of absolute or relative insulin deficiency with blood sugar over 250 mg/dl). In the long run, uncontrolled blood sugar can also damage the vessels that supply blood to important organs, like the heart, kidneys, eyes, and nerves.
This can occur even when patient feels OK. That’s why it’s so important to take action as soon as person is diagnosed with diabetes – foot problems are a common problem for patients with diabetes. The signs and symptoms of foot problems to emphasize are: feet that are cold, blue or black in color, feet that are warm and red in color, foot swelling, foot pain when resting or with activity, weak pulses in the feet, not feeling pain although there is a cut or sore on the foot, shiny smooth skin on the feet and lower legs.
Patient need to care for her feet by washing them daily, drying them carefully particularly between the toes, and inspecting for corns, calluses, redness, swelling, bruises, blisters, and breaks in the skin. Patient should report any changes to her health care provider as soon as possible and needs to treat all injuries, cuts and blisters particularly on the legs or feet carefully. -patient should have an eye examination by an ophthalmologist or optometrist when first diagnosed with diabetes.
The reason for this is that blood sugar levels often increase over a period of several years before the person is diagnosed. Eye complications can develop during this time and often have no symptoms. Having an eye examination soon after diagnosis can help to determine if there are eye complications, the extent or severity of the complications, and if treatment is needed Regular eye examinations are essential for detecting eye complications (called retinopathy) at an early stage, when the condition can be monitored and treated to preserve vision. Manage high blood pressure with lifestyle modifications and/or medication(s). Patient should maintain a blood pressure within normal range (120/80 mm/Hg), or as close to normal as is safely possible High blood pressure stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eyes. -to avoid complication of diabetes it is recommended for the patient to decrease or quit smoking. Smoking and diabetes both have many of the same health problems in common. Both can damage the heart and the circulation. Both can raise patient’s blood pressure and cholesterol levels.
Smokers also have a harder time controlling their blood glucose levels, because insulin resistance is increased by smoking – patient already having problems with urination is strongly recommended in the future to use proper toilet hygiene, prompt urination after sexual intercourse, regular emptying of the bladder and adequate fluid intake. People with diabetes are more adversely affected when they get an infection than someone without the disease, because diabetics have weakened immune defenses. Good urinary hygiene, can help minimize the possibility of developing urinary tract infections. Following a proper diet is important for helping to regulate patient’s blood sugar levels, and patient should develop her individual eating plan. Diet Recommendations: -Decrease intake of processed foods Examples: candy, high sugar cereals and white breads, crackers, pastries, cookies etc – Decrease overall intake of fats and salt – Decrease overall daily calorie intake – Increase intake of Fruits and Vegetables – Increase intake of High Fiber Grains Examples: Whole Wheat Breads and Cereals, Oatmeal, beans, brown rice, nuts, etc. 3. Home blood sugar ( glucose) levels are usually part of controlling blood sugar for people with diabetes.
One important goal for diabetes treatment is to keep the blood glucose levels near the normal range of 70-120 mg/dl before meals and under 140 mg/dl at 2 hours after eating. Since blood glucose levels can fluctuate widely, even frequent home glucose testing may not accurately reflect the degree of success in controlling blood sugar. The hemoglobin A1C test is a valuable measure of the overall effectiveness of blood glucose control over period of time. The test measures the amount of sugar that attaches to the protein in the red blood cell.
The test shows the average blood sugar during the last three months. The higher the blood sugar the higher the HbA1c. The high blood sugar over a long period of time causes damage to the large and small blood vessels therefore increasing the risk of complications from diabetes. 4. Hypoglycemia is a condition that occurs when the blood sugar (glucose) is too low. Blood sugar below 70 mg/dL is considered low. The most common causes of low blood sugar in people with diabetes are: •Taking your insulin or diabetes medicine at the wrong time •Taking too much insulin or diabetes medicine by mistake Not eating enough during meals or snacks after you have taken insulin or diabetes medicine •Skipping meals •Waiting to eat your meals •Exercising more or at a different time than usual Early signs of hypoglycemia may include: hunger, shaking, fast heartbeat , weakness or even confusion. Eat something that has about 15 grams of carbohydrates. Examples are: •3 glucose tablets •A 1/2 cup (4 ounces) of fruit juice or regular, non-diet soda •5 or 6 hard candies •1 tablespoon sugar, plain or dissolved in water •1 tablespoon honey or syrup Untreated, hypoglycemia from too much insulin can lead to loss of consciousness and coma.
Patients with diabetes should always carry some snacks with them in case of hypoglycemia. 5. Hyperglycemia is the technical term for high blood glucose (sugar). High blood glucose happens when the body has too little insulin or when the body can’t use insulin properly so too much sugar in the blood. Early signs of hyperglycemia in diabetes may include: blood sugar above 200mg/dl, rapid or weak pulse, skin flushed, hot and dry, low blood pressure, drowsiness. If breath has sweet, fruity odor- risk of developing diabetic ketoacidosis( medical emergency).
A number of things can cause hyperglycemia: not enough of insulin given, or insulin is not as effective as it should be, patient ate more food than he/she planned, stress from an illness, such as a cold or flu ,or other stress, such as family conflicts etc. To prevent hyperglycemia/hypoglacemia in diabetes, patient must follow her meal plan, exercise program, and medicine schedule. •Know your diet, count the total amounts of carbohydrate that you are consuming •Test your blood sugar regularly. •Know that you have to contact your health care provider if you have repeated abnormal blood sugar readings. Make sure you always wear medical identification that states you have diabetes so you can receive proper treatment in the event of an emergency. The patient needs to be reminded to record the blood glucose values on a log sheet with the date and time and any associated signs and symptoms that he/she is experiencing at the time the specimen was obtained. This log should be shared with his/her primary care practitioner. The purpose of the sliding scale is to lower down elevated blood sugar level by rapid acting or regular acting insulin subcutaneously.