• 20.8 million in U.S.• 1 in every 400-600 children in U.S.

have Diabetes• Most common in African American,

Native American, Hispanic• Increases with age• Pre-diabetes- blood sugar is higher

than normal, but not diabetic yet

Cause is not fully understood; however, incidence is increase by:

Heredity Obesity Age Diet Lack of exercise

What are the 6 nutrients????When we eat we digest then absorb nutrients into our bloodWhat nutrient is used for energy???As our body breaks down the carbohydrates FOR energy, the carbs are actually broken down into starches and sugar and then further into their simplest form known as glucose.Our pancreas secretes insulin so that the glucose molecules in our blood can be metabolized.

• Starches and sugar- make up carbohydrates• Carbohydrates-nutrient that body uses for

energy• Metabolism-process of breaking down food to

be used as energy• Glucose-simplest form of carbohydrate

metabolism• Pancreas-endocrine gland that secretes insulin• Insulin-hormone that regulates blood sugar

levels• 80-120- normal blood sugar level in body

When we eat our body uses carbohydrates (starches/sugar) for energy. Our body metabolizes carbohydrates by breaking them down into their simplest form known as glucose. Once levels of glucose (sugar) rise in the blood, our pancreas responds by secreting insulin. Insulin is a hormone that attaches to the glucose and actually allows our body to use it as it breaks it down. The insulin maintains the normal level of glucose (blood sugar) in our body at a level of 80-120. This is naturally done through homeostasis.

What does the body normally use for energy? What is the “simplest” form of carbohydrate

metabolism? What is the endocrine gland that secretes insulin? What is the process of “breaking down”

food/nutrients to be used as energy? What is the hormone secreted by the pancreas to

control blood sugar? What is the normal blood sugar level in the body? What are carbohydrates made up of?

Diabetes is a SILENT, METABOLIC disease that can affect your eyes, nerves and kidneys over time. It is a CHRONIC disease of deficient carbohydrate metabolism due to lack of OR resistance to the effects of INSULIN.

These problems with insulin cause the body to be unable to properly process or metabolize food into energy. The glucose from the food breakdown (carbohydrates—starches—simple sugars) remain in the bloodstream, resulting in persistent elevated blood sugar levels.

Metabolism- breaking down to use for energyGlucose- simple sugarInsulin-hormone secretes by pancreas that

lowers glucose levelsPancreas-organ that produces insulinCarbohydrates-nutrient class used for energyFats & Proteins-next nutrient class used for energyKetones-acid by products of fat metabolismFluid & Electrolyte (F&E) Imbalance-when fluids

and electrolytes (potassium, sodium) are imbalanced

Cells do not “pick up” the glucose and metabolize it for energy because there is no insulin, not enough insulin, or the body is resistant to the insulin. Insulin allows the cells to use the glucose and metabolize it for energy.

Because cells can’t metabolize or use the glucose, they have to get energy somewhere else, so they metabolize fats and proteins.

The by-products, or end results of fat and protein metabolism causes ketones to build up in the blood. Ketones are acids that are NOT normally found in the body. The body tries desperately to get rid of these “acids” and excess glucose in the blood, so the kidneys respond by eliminated large amounts of water and salt. This causes intense dehydration and fluid and electrolyte imbalance

1. What does the body normally use for energy?2. What allows glucose to be used for energy?3. What can’t the diabetic “use” glucose for

energy even if it’s in his/her bloodstream?4. What must the diabetic metabolize for energy

when carbohydrates (glucose) are “unavailable?”

5. What causes ketones to build up in the blood?6. What causes the F&E imbalance?

80-120

We cannot survive WITHOUT a blood sugar (glucose) level.

Before developing Type 2 diabetes, most people develop prediabetes which is when the blood glucose is higher than normal, but not high enough to be called diabetes

Type 1 or Insulin Dependent (IDDM)

Juvenile Diabetes“Brittle” diabeticUsually appears in

youth or under age 40

Severe and unpredictable

Requires insulin

Type 2 or Non-Insulin Dependent (NIDDM)

Adult onset DiabetesMakes up 90-95% of

all diabetics10X more commonBegins in later years,

although seeing more in children d/t obesity

Type 1:1. Polyuria2. Polydipsia3. Polyphagia4. Glycosuria5. Weight loss

Type 2:1. Fatigue2. Slow healing

wounds3. Multiple skin

infections, UTI4. Vision changes5. Obesity

1. Drugs:Insulin- injection only!

RN only!Insulin pump

Oral Medications

Only for Type 2

2. Diet• Weight reduction• Diabetic diet/Exchange

system: Utilizes exact calorie

count, measuring foods to individual needs.

If you have diabetes, your doctor may put you on a diabetic exchange diet to help control both your weight and the amount of sugar and cholesterol in your blood. You will need to measure your food while on this diet, and you will probably need to eat 3 meals and 1 to 3 snacks daily. This diet divides the foods you can eat into 6 groups and measures each food by exact serving size. That way you can be sure to eat the right amount from each food group daily.

3. Exercise:Helps keep body fit

Burns off caloriesHelps control glucose stores

Acute Complications1. Insulin Shock/Too much

insulin/Hypoglycemia2. Diabetic Coma/Too much

glucose/Hyperglycemia

Chronic Complications3. Circulatory System Complications

4. Nervous System Complications

1. Hypoglycemia/Insulin Shock• Sudden onset• BS drops below 70, so insulin level increases

Causes: Received too much insulin Too much physical activity

StressVomiting

Symptoms:

Excessive sweating Rapid breathingFainting Moist, clammy skinNumbness Agitated,

nervousnessPaleSlurred speechRapid, thready pulse

Treatment:Sugar/OJ if awakeIV glucoseOral glucagon

2. Hyperglycemia/Diabetic Coma• Also called KETOACIDOSIS- body

becomes too acidic d/t increased levels of ketones in blood

• Too much glucose in blood; over 250• Develops more slowly (can be 24 hours to

days)• Usually with Type 1

Causes:Insufficient insulin

StressIllness/infection

DehydrationForgotten medicine

Intake of too much food

Why is the blood so acidic? Where are all the ketones coming from?

Medical emergency!!!!

Symptoms:• Headache, drowsiness, confusion• Labored/irregular breathing (Kausmaull’s)• N&V• Weakness Unconsciousness• Flushed and dry skin• Lethargic/confused• Vitals are normal (**at first), then low BP• Sweet, fruity odor to breath

Treatment:IV insulinFluidsElectrolytes

3. Circulatory System Complications:Increased levels of glucose in blood, overtime,

causes RBC to become stiff damaging the vessels especially the smaller capillaries. This causes poor circulation. The poor circulation

has systemic affects:1. Decreased ability to fight infection

2. Poor healing3. Diabetic Retinopathy (eye disease leading to

blindness)4. Kidney disease

4. Nervous System Complications:

The higher than normal levels of glucose in the bloodstream overtime, also damage

the small nerves that extend to the periphery. This causes:

1. Peripheral Neuropathy- pain in nerves2. Loss of sensation

1. Glycated hemoglobin test (A1C)- blood test done approximately every 3 months that measures the glucose level in the blood over a prolonged period of time. It provides a “snapshot” of the patient’s diabetic control. It is not a screening test; it helps predict and control the risk for development of the chronic complications.

2. Fingerstick blood sugar- testing a sample of capillary blood to obtain quick and accurate blood sugar level.

Urine test- Checking urine for “spilling” of glucose and/or ketones. If the blood has higher than normal levels of glucose and ketones, it will actually “spill over” into the urine.

Test will not give an actual number, but rather a 1+, 2+, 3+.

Use the multistix to “dip in” urine.

Nursing care of the diabetic patient centers around:

• Skin care• Foot care• Poor circulation• Peripheral neuropathy• Blood sugar monitoring

1. Prevent skin irritation2. Inspect skin with all care3. Special foot care: do NOT cut toe nails,

avoid tight fitting shoes, pt. cannot walk barefoot, wash and DRY feet/toes throuroughly.

4. Inspect feet; have patient inspect feet. The peripheral neuropathy AND poor circulation increases risk of infection, gangrene and possible amputation. Pg.739

5. Keep room clutter free6. Follow appropriate diet/diabetic restrictions.7. Accurate finger stick/urine testing.8. Support lifestyle changes with reassurance and psychological encouragement.