what are the faces of diabetes? alteration in metabolism

What are the FACES of Diabetes?

Alteration in Metabolism

Cost/Fiscal Burden

• How much money is it estimated that Diabetes

costs this nation annually?

• What does that mean to you as a nurse?

Prevalence

• How many people are affected with diabetes?

• How many people are newly diagnosed with diabetes annually?

• What percentage of the people with diabetes have Type 1 vs. Type 2?

• What does that make you think?

Prevalence

• In 1985 how many people/children under the age of 20 were diagnosed with type 2

diabetes?

• In 2009 how many people/children under the age of 20 were diagnosed with type 2

diabetes.

Morbidity and Mortality

• Diabetes is the ______ leading cause of death in the US.

• What leading illnesses does diabetes contribute to?

• What does that make you think????

What is the FACE of Diabetes?

What is ???????

• Insulin

• Glucose

• What is the primary source of energy for your body? What else can it use?

• What is the primary source of energy for your brain? What else can it use?

• What is hypo/hyper glycemia?

What happens to our body when?

• Hypoglycemic

• Hyperglycemic

What happens to our bodies when we are hyperglycemic?

Blood Glucose >110

InsulinResistance

DecreasedInsulin

IncreasedFree Fatty

Acid

OxidativeStress

OxidativeStress

Nitric Oxide

Endothelin-1

Angiotensin ll

Vasoconstriction

Nitric Oxide

Angiotensin ll

Activation of activator protein -l

InflammationhypertensionVascular smoothmuscle cell growth

Release of chemokinesRelease of cytokinesExpression of cellular adhesion molecules

Nitric oxideTissue factorPlasminogen ActivatorProstaccyclin

Thrombosis

Hyper coagulationPlatelet ActivationDecreased Fibrinolysis

So what disease states are you at risk for???

• MI

• DVT

• PE

• Stroke

• AAA

• Retinopathy

What happens to our bodies when we are hyperglycemic?

MetabolicStress Response

Stress hormones and peptides

Increased Glucose Increased Glucose Decreased InsulinDecreased Insulin

Increased Glucose Decreased Insulin

Increase in:Ketones

Free Fatty AcidsLactate

ImmuneDysfunction

Reactive 02Species

InfectionDissemination Increase

TranscriptionFactorsLeads to

SecondaryMeadiators

DID YOU KNOW ANY BLOOD SUGAR GREATER

THEN ________ STARTS THESE PROSES?

WHAT DOES IT DO TO YOUR IMMUNE SYSTEM?

Case Study

Mrs. Sugar is a 57 year old obese female patient, her height is 5’ 3” that has been seeing the same PCP for 15 years. She is in for her annual check up. She has a history of HTN, bronchitis, COPD, sedentary lifestyle, non compliance with diet and exercise recommendations. Mrs. Sugar had her lab work done prior to coming to the PCP and these were the results:

• -Complete Blood Count VS

• WBW-13.5 Na-140 B/P 150/67

• RBC-5.5 K- 4.0 HR 77

• HGB- 12.0 Glucose-205 RR 18

• HCT-32 HbgA1c-8 Temp. 98.6

• Weight-210 Bun/Creat- 18/1.4

Assessment Data

• What other assessment data will What other assessment data will you obtain and why?you obtain and why?

– SubjectiveSubjective

– ObjectiveObjective

Optimal Levels of Blood Sugars/Glucose

• Preprandial-110 mg/dlPreprandial-110 mg/dl

• Postprandial-180 mg/dlPostprandial-180 mg/dl

What is her diagnosis?????

What type of medication should the PCP start Mrs. Sugar on and why?

How will you monitor if the medication is effective or not?

What nursing diagnosis would be appropriate at this time?

What teaching must be done at this time?

What goals would you set with the patient?

Mrs. Sugar has come in every month for 3 months and has been doing well.

Mrs. Sugar returns to the office 10 months from her original diagnosis b/c she is not feeling well. She said she has had a cold, runny nose, non productive cough, post nasal drip, and has had a low grade fever of 100.9.

You assess Mrs. Sugar VS: B/P 95/69, HR 106, RR 15, O2 sat RA 91%, Temp. 101. Heart tones clear, pulses palp, Lungs diminished in that bases with crackles and patient appears SOB, fruity breath, mocous membranes are dry, patient has not c/o GI upset and is able to urinate w/o difficulty but is going all the time in large amounts. Denies pain at this time. She is sent to the ER.

You are the ER nurse you assess the You are the ER nurse you assess the patient and all the data is the same as patient and all the data is the same as the office nurse.the office nurse.

What assessment would you do next?What assessment would you do next?

Mrs. Sugar is admitted to the hospital Mrs. Sugar is admitted to the hospital for What????for What????

What is the most sever complication of DKA?

What do you anticipate your orders to be and why?

What are some nursing diagnosis at this time?

Mrs. Sugar is very upset and states b/c she has never had to take insulin before, she just takes the pills. How will you respond to her?

Prior to being discharged you review Mrs. Sugar’s Blood Sugar Diary. You note there were many times during the day that her glucose was above 200. You show this to the endocrinologist and they wrote orders that the patient will go home on insulin, along with the oral hypoglycemic agents.

What education do you anticipate needing to review with Mrs. Sugar?

Mrs. Sugar was seen 1 week after Mrs. Sugar was seen 1 week after discharge and dong well. She discharge and dong well. She maintained her preprandial blood maintained her preprandial blood sugar below ??? and post prandial sugar below ??? and post prandial below ??? She has also lost 20lbs.below ??? She has also lost 20lbs.

6 months later you are reviewing Mrs. 6 months later you are reviewing Mrs. Sugars labs and note that her renal Sugars labs and note that her renal and hepatic function are abnormal.and hepatic function are abnormal.

What can this be due to?What can this be due to?

B/C Mrs. Sugar was so compliant with B/C Mrs. Sugar was so compliant with her medication and diet what can we her medication and diet what can we recommend her to use for her recommend her to use for her diabetes?diabetes?

Insulin PumpInsulin Pump

Why are they better for patients?Why are they better for patients?

What type of insulin can be used with What type of insulin can be used with AN INSULIN PUMP?AN INSULIN PUMP?

New Case Study

• Mandy is a 18 year old girl who has had type 1 diabetes since she was 2 years old. She has been to the office/then hospitalized several time this year with elevated blood sugars >500 and ketones in her urine.

• Mandy has been having trouble at home following her parents rules and has been sneaking out at night and drinking alcohol. Her parents said she has a boyfriend and he encourages this behavior as well.

• What does alcohol do to your blood sugar?

• What medical diagnosis was she admitted for several times this year?

• ‘What are the potential complications of this diagnosis?

• Mandy has presented to the ER the 3rd time this month in DKA. She was unresponsive when she arrived. She was admitted to the ICU on an insulin drip. Her blood sugar is stabilized and she wants to sign out AMA, which she has done the 3 prior admissions.

• Mandy is now yelling at you and telling you she wants to get the hell out of here and get her the paperwork. She is crying.

• As the nurse how do you handle that situation?

• What do you say to Mandy?

• Who do you need to notify?

What nursing diagnosis may apply???

• You over hear Mandy talking with her mother and she is still crying. Mandy says “He thinks I am strange bc I have to watch what I eat and give myself shots. I hate it. I love him so much and I don’t want to live if I cant have him.”

• What do you think about that statement and what do you do?

• Can you let Mandy just leave?

• Do you call her mother or boyfriend and tell them to convince her to stay?

• What do you think may be going on and why?